C10032466 / invoice 10000

Reason: Review - Still Vomiting Appointment Notes: Bad debtorReason: Client Present:Nurse:ATV+ 3x today Ate some food this morning History: Moose pe-presentation for ongoing vomiting and lethargy. Seen by RK yesterday 13/03/2026 for the similar clinical signs. Diagnostics performed yesterday included abdominal radiographs and blood work, which were reportedly unremarkable, though radiographs showed evidence of mild faecal impaction in descending colon.Ate a small amount after discharge yesterday, but subsequently vomited. Vomited again this morning after eating. The vomitus today was yellowish in color. The vomiting is occurring after eating.Moose passed a few small, hard faeces earlier this morning, nothing this afternoon.Owner reports lethargy and reduced activity. Appetite is present, but eating more slowly than usual.Owner is confident there has been no recent foreign body ingestion, though there is a history of dietary indiscretion. No recent changes to diet, which consists of high-quality kibble and mince.EXAMINATION:QARHR 102 RR panting MM pink CRT 2sec temp 38.4 rectalCV no murmurs or arrhythmiasResp normal bronchovesicular soundsAbdomen palpation initially tense on palpation cranial abdomen, but then relaxedRectal exam - scant faecesMSK ambulatory, normal musculatureSkin soft coatOpth clear eyes, normal pupilsLN submandibular LN NADPROBLEM LIST:Vomiting (4-day history)Constipation/obstipationLethargyInappetence/hyporexiaDIFFERENTIAL DIAGNOSIS/DIAGNOSIS:Gastrointestinal stasis/ileusGastrointestinal foreign body obstructionGastroenteritis (viral/bacterial)Pancreatitis**ASSESSMENT:**Vomiting - DDx GI (gastroenteritis, dietary indiscretion, IBD, ileus), extra GI less likely given blood results, possibly foreign body (owner says unlikely)LethargyDiscussed with owner possible causes of vomiting as above. Discussed options fo repeat xrays (need to be done at AEC given time this afternoon) or trial supportive treatment eg SC fluids and anti-nausea injection promote gastrointestinal motility and hydration. Owner agreed to supportive treatment**TREATMENT:**Cerenia 33mg administered subcutaneously for anti-nausea effects.Subcutaneous fluid therapy administered 350ml SC (approx 10ml/kg)PLAN:Home into owner's care for monitoring overnight.If vomiting continues or condition deteriorates, the owner is advised to present to the Animal Emergency Centre for reassessment.The emergency centre can perform further diagnostics including repeat radiographs, lactate/blood gas to assess perfusion, and potentially an abdominal ultrasound to rule out an obstructive process.If signs resolve, continue to monitor at home. If signs persist by Monday, a follow-up visit is recommended for potential repeat imaging (radiographs or formal ultrasound).CLIENT COMMUNICATION:Discussed the clinical findings and concerns with the owner. Explained the rationale for treatment with an anti-emetic (Cerenia) and subcutaneous fluids. Advised that if vomiting persists or Moose's condition worsens overnight or on Sunday, he must be taken to the emergency centre for further evaluation and treatment. The potential for the emergency centre to perform further diagnostics like repeat X-rays, specific blood tests (e.g., lactate, blood gas), and an abdominal ultrasound was explained. Discussed that if he is still unwell on Monday, we can arrange further diagnostics here, such as repeat radiographs or ultrasoundScripts Needed - Yes or NoRevisit needed - Yes or No - ____ Days pleaseHistory-Update:Consent has been given by the client to proceed with this treatment  -  Yes/No Reason: Nurse: -vaccination -heartworm -worming -flea/ticks Exam: Lab: Assessment: Treatment: Plan:IV & Fluid Therapy: Catheter Removal    Vital Signs    Weight: 33.2;       Temperature: 38.4;