C10032307 / invoice 10000

Reason: L3: 50g Dark Choc 10:30-NoonHISTORY:Current meds:Prophylaxis:Pre-existing conditions:Access to toxins eg. Rodenticide:TRIAGE:HR:RR:Temp:Mm: Crt:Mentation:Pain Scale (0-4):Hydration status (%):EXAMINATION:Body Condition Score: Cardiovascular: cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeNeurological: neurologically no significant findings, no cranial nerve or proprioceptive deficits/gaitMusculoskeletal: ambulating normally, no palpable neck, spine, limb or joint painGastrointestinal:- Oral: normal, no mouth pain, dental score (1-4):  - Abdominal: no detectable pain on abdominal palpation, normal gut sounds- Rectal: no detectable abnormalities, faeces:  Urinary: NSFReproductive (incl ext genitalia): NSFIntegument/Ears: NSFLymph Nodes: peripheral lymph nodes normalEyes: NSFPROBLEM LIST:DIFFERENTIAL DIAGNOSIS/ DIAGNOSIS:DIAGNOSTIC/MANAGEMENT PLAN:DIAGNOSTICS:ASSESSMENT:TREATMENT:PLAN:CLIENT COMMUNICATION:Emesis - Apomorphine 0.04mg/kg IV. - Metoclopramide 0.5mg/kg IV following emesis. - Activated Charcoal + Sorbitol 0.5g/kg PO.    Vital Signs    

Reason for Presentation: Ingestion of dark chocolateHISTORY:- Ingested large quantity of Lindt dark chocolate balls within last 2-4 hours- Otherwise wellCurrent meds: No medicationsProphylaxis: Up to datePre-existing conditions: No known underlying conditionsAccess to toxins: No known access to any toxins, bait, rubbish, medications, chemicals nor anything else that could have been scavengedTRIAGE:- HR: 140 bpm- RR:- Temp: 38.0°C- Mm: Pink- CRT: <2- Mentation: BAR- Pain Scale (0-4):- Hydration status (%):- Body Condition Score:Cardiovascular: Cardiac auscultation normal, normal rhythm, pulse pressures normal and synchronousRespiratory: Thoracic auscultation clear sounds bilaterally, respiratory effort normal, no nasal dischargeMusculoskeletal: Ambulating normally, no apparent neck, spine, limb or joint pain, full musculoskeletal exam not performedGastrointestinal:- Oral: No significant findings- Abdominal: No significant findings- Rectal: Not performedUrinary: No significant findingsReproductive (incl ext genitalia): No significant findingsIntegument/Ears: No significant findingsLymph Nodes: WNL on palpationEyes: No significant findingsPROBLEM LIST:1) Methylxanthine ingestionASSESSMENT:Successful emesis of large quantities of chocolate. No further concern expected. Risk of pancreatitis noted.TREATMENT:- Apomorphine 0.44mg/kg SC- Metoclopramide 0.5mg/kg SC- Activated charcoal 5ml POPLAN:Discharge home to owners care, revisit with primary care veterinarian or with PVE if any ongoing concerns.Diagnosis: Chocolate Ingestion/Toxicity   Treatment Summary:   Your pet has been administered a medication to induce vomiting (emesis) to try and remove the toxin from the stomach.They have also been administered an anti-nausea medication to reduce the risk of further vomiting, and some oral charcoal to help bind any remaining toxin in the gastrointestinal tract.  Monitoring at home:* It is possible that your pet may have a further vomit, if this does occur it is likely to occur within 15-30 minutes of discharge.* The mediations administered may also cause some sedation for up to an hour and should be closely monitored for the first few hours once at home.* It is not recommended to feed your pet within the first 2 hours after having induced vomiting.* If there is continued vomiting, your pet becomes dull or lethargic or there are any other concerns, please contact Perth Vet Emergency or your primary care veterinarian immediately.  Chocolate toxicity: Chocolate ingestion can be life threatening, it can result in severe elevations in heart rates and abnormal heart rhythms, and neurological signs such as tremoring and seizures. Occasionally patients with severe intoxication will require intensive care in hospital.  It is not uncommon for chocolate ingestion to result in gastrointestinal upset, and chronic complications such as pancreatitis. The best way to manage chocolate ingestion is to seek veterinary treatment straight away, so that none of the life threatening symptoms of the toxicity have time to appear.   Exercise: If your pet has had gastrointestinal upset or neurological signs, please keep your pet rested for the next 2-5 days then gradually reintroduce normal activity over the following week.   Diet: If your pet has shown gastrointestinal upset from chocolate ingestion, please feed your pet bland food boiled skinless chicken and rice for 3-4 days and gradually reintroduce normal food. Black diarrhoea can be noted due to charcoal administration.   Recheck: Once your pet is discharged home Perth Vet Emergency advises a reassessment with your primary care veterinarian within 48 hours to monitor your pet’s progress.  If your pet's condition deteriorates, they become flat or lethargic, go off their food and water and develop vomiting, diarrhoea or tremoring and seizures or if you have any concerns please contact PVE or your primary care veterinarian immediately.   If your pet is going home and has a pressure wrap over where an IV catheter was placed please remove it within 20 minutes of leaving the hospital. If your pet's condition is not improving or if other problems develop, please call your primary care veterinarian or if it is outside their normal working hours, please call Perth Vet Emergency.  Thank you for trusting our team with the care of your pet.    Vital Signs