C10032807 / invoice 10000

Reason: Pancreatitis, Splenic Thrombi, Possible DICRecord is In/CompleteReason:Hospital Day:ICU DAYTIME SOAP day shiftCase Summary: Case Summary:- Schnitzel is D4 hospitalisation for acute pancreatitis and thromboembolic disease (splenic, hepatic and CVC thrombus noted on AUS 11/3)Case synopsis: 10/3: - CBC performed on 10/3 revealed anaemia (HCT @ 28.9, strongly regenerative - Retic @ 249.1), Mild neutrophilia @ 11.72, mild eosinopenia @ 0.02. Moderate thrombocytopenia also noted (plt @ 77k/uL - confirmed on smear)- Biochem on 10/3: Crea low @ 40umol/L. Mild hyponatremia @ 141mmol/L. Moderate hypokalemia @ 2.8mmol/L. Mild hypochloremia @ 105mmol/L- Coags: Mild prolonged aPTT @ 115s. PT WNL- Cortisol: 239.7nmol/L11/3:- AUS: consistent with acute pancreatitis + TE disease (Splenic, hepatic and CVC thrombus). Moderate peritoneal effusion noted- Commenced on anti-thrombotic therapy and supportive care overnight12/3:- O-tube placed and commenced enteral nutritionYesterday:- Schnitzel remained QAR: diarrhoea reducing and mre comfortable on abdominal palpation since commencing low-dose fentanyl CRI. - Peritoneal effusion persists but less severe than previous- Remains inappetent but tolerating 33% RER via O-tube, overnight increased to 66% RER but started regurgitating againObjective:- Demeanour: Not interested in food. Seemingly ok but still a bit uncomfortable in the abdomen off fentanyl. More comfortable after administration of buprenorphine, but still exhibits some mild abdominal discomfort in the afternoon.TPR- HR: 84 beats per minute- RR: 24 per minute, normal efforts- MM Colour: pink- CRT: 1 second- Temp: 39.5 degrees Celsius in the morning, resolved within 3 hrs (suspect mroe stress related).- Blood pressure: 135 millimetres of mercury via DopplerAbdo/ALI: Small amount of regurgitation in the morning. Ongoing diarrhoea. Not eating voluntarily. A FAST scan in the morning showed the stomach was moderately sized with fluid content and poor peristalsis in am. In the afternoon, the stomach was smaller with better movement. Still small pockets of free fluids, hyperechoic thickened mesenteryDiagnostics:- Abdomen panel: Packed cell volume/total protein was 33/58 with icteric serum.- Acid-base and electrolytes: Unremarkable.- Total bilirubin (radiometer): 39.- Total bilirubin (catalyst): 70, an increase from 32 yesterday.- Blood glucose: Stable on 2.5% glucose supplementation.Assessment:- Worsening icterus.- The anaemia seems to be improving.- The worsening icteric picture likely represents hepatic thrombosis and/or clot lysis but may also represent active hepatic injury eg from microthrombi, or hemolysis (although pcv increasing makes this less likely)(Treatment:- Feeding was delayed and then restarted at 33% of resting energy requirement, which was better tolerated.- Trialled off fentanyl and started on buprenorphine for abdominal discomfort - consider restarting low dose fent as abdo still bit uncomfortrable- Continued metoclopramide.- Added erythromycin at one milligram per kilogram intravenously every eight hours as a prokinetic.- refer to flowsheet for full treatment planPlan:- Continue supportive care for pancreatitis, subsequent peritonitis, and thromboembolic disease.- Consider trialling off glucose supplementation tonight.Updated owner in morning with progress in morning, came to visit at lunchtimeReferring Veterinarian Communication: Daily update emailed to referring vet : YES/NO Time:    Vital Signs    Weight: 5.1;