Charlene0718
Member
Sir thomas vet notes update/ summarized:
Emergency Discharge Summary
Sir Thomas presented to us for evaluation (Note: I brought him in with reported 3.8 BG and administered honey). He had previously been diagnosed with diabetes. All along he has not been eating well. He has been becoming hypoglycemic, even with decreasing doses of insulin. SIr Thomas's vital parameters were within normal limits. On physical examination, we found that he appeared slightly dehydrated.
Diagnostic test results:
1. Bloodwork:
1. Liver values were mildly elevated (improved compared to regular vet bloodwork)
2. the blood sugar level was high on presentation but became more normal during his stay. We suspect that he had a high blood glucose initially due to stress. His previous high blood glucose and high serum fructosamine were suggestive of diabetes melitus. This change/improvement in his ability to regulate his blood sugar suggests that he either went into diabetic remission quickly and/or was 'pre-diabetic'
2. Urinalysis
1. Some glucose and struvite crystals
3. Abdominal Ultrasound:
Conclusions:
1. mild hyperechoic mesentery surrounding the kidneys. Differentials include an acute kidney injury from a toxin vs a inflammatory glomerular or interstitial nephritis vs less likely a pyelonephritis. It is unlikely that this is a normal finding for this patient.
2. Multiple chronic renal infarcts, left kidney
3. Diffusely, homogeneously hyperechoic hepatic parenchyma. The differential is an endocrine-associated vacuolar hepatopathy such as the clinically reported diabetes melitus. A component of hepatic lipidosis may also be present.
4. echogenic urinary debris. Differentials include crystalluria, lipiduria, or cellular debris (hemorrage vs pyuria)
4. Fine Needle aspiration of the liver was performed, cytology results are pending and we will contact you in 2 to 3 business days with results.
In hospital treatments:
1. Provided with continuous IV fluids
2. We gave injectable anti-nausea medication as well as pain medication
3. We monitored his blood sugar level
1. His Blood Glucose was not consistently/ persistently >15mmol/L, therefore we did not start him back on insulin (I will chart on his SS the numbers they gave me)
Medications to go home
-discontinue Atopica
-gabapentin - give 0.9ml by mouth every 8 to 12 hours for pain, may cause mild sedation.
-marbofloxacin- give 1 by mouth every 24 hours with food until finished. Antibiotic.
-Mirtazapine- Give 1/4 of a tablet by mouth every 24 hours as an appetite stimulant.
Aventi Liver- Give 1/4 tab by mouth every 12 hours until finished. Liver detoxifying medication
Diet: daibetic diet, less than 7% carb content
Follow up: recheck blood glucose at home, 4-5 samples per day; note times he ate during the day. report info to regular vet and keep a close eye on thirst and urination (drinking more than 90ml/kg/day is considered excessive, appetite, vomitting, diarrhea
If he conitnues to have poor appetite, blood sugar is difficult to interpret, or you have any other concners, we recommend you recheck with your regular vet and also seek out an internet medicine consultation for further work up and diagnosis (she told me to do this asap to get on a wait list). Ideally recheck full bloodwork including urinalysis) in 10 days prior to discontinuing marbofloxacin
Monitoring: Please monitor for vomiting, diarrhea, not eating, tremors. If you notice any of these signs or have concerns, please contact ER or your vet
Emergency Discharge Summary
Sir Thomas presented to us for evaluation (Note: I brought him in with reported 3.8 BG and administered honey). He had previously been diagnosed with diabetes. All along he has not been eating well. He has been becoming hypoglycemic, even with decreasing doses of insulin. SIr Thomas's vital parameters were within normal limits. On physical examination, we found that he appeared slightly dehydrated.
Diagnostic test results:
1. Bloodwork:
1. Liver values were mildly elevated (improved compared to regular vet bloodwork)
2. the blood sugar level was high on presentation but became more normal during his stay. We suspect that he had a high blood glucose initially due to stress. His previous high blood glucose and high serum fructosamine were suggestive of diabetes melitus. This change/improvement in his ability to regulate his blood sugar suggests that he either went into diabetic remission quickly and/or was 'pre-diabetic'
2. Urinalysis
1. Some glucose and struvite crystals
3. Abdominal Ultrasound:
Conclusions:
1. mild hyperechoic mesentery surrounding the kidneys. Differentials include an acute kidney injury from a toxin vs a inflammatory glomerular or interstitial nephritis vs less likely a pyelonephritis. It is unlikely that this is a normal finding for this patient.
2. Multiple chronic renal infarcts, left kidney
3. Diffusely, homogeneously hyperechoic hepatic parenchyma. The differential is an endocrine-associated vacuolar hepatopathy such as the clinically reported diabetes melitus. A component of hepatic lipidosis may also be present.
4. echogenic urinary debris. Differentials include crystalluria, lipiduria, or cellular debris (hemorrage vs pyuria)
4. Fine Needle aspiration of the liver was performed, cytology results are pending and we will contact you in 2 to 3 business days with results.
In hospital treatments:
1. Provided with continuous IV fluids
2. We gave injectable anti-nausea medication as well as pain medication
3. We monitored his blood sugar level
1. His Blood Glucose was not consistently/ persistently >15mmol/L, therefore we did not start him back on insulin (I will chart on his SS the numbers they gave me)
Medications to go home
-discontinue Atopica
-gabapentin - give 0.9ml by mouth every 8 to 12 hours for pain, may cause mild sedation.
-marbofloxacin- give 1 by mouth every 24 hours with food until finished. Antibiotic.
-Mirtazapine- Give 1/4 of a tablet by mouth every 24 hours as an appetite stimulant.
Aventi Liver- Give 1/4 tab by mouth every 12 hours until finished. Liver detoxifying medication
Diet: daibetic diet, less than 7% carb content
Follow up: recheck blood glucose at home, 4-5 samples per day; note times he ate during the day. report info to regular vet and keep a close eye on thirst and urination (drinking more than 90ml/kg/day is considered excessive, appetite, vomitting, diarrhea
If he conitnues to have poor appetite, blood sugar is difficult to interpret, or you have any other concners, we recommend you recheck with your regular vet and also seek out an internet medicine consultation for further work up and diagnosis (she told me to do this asap to get on a wait list). Ideally recheck full bloodwork including urinalysis) in 10 days prior to discontinuing marbofloxacin
Monitoring: Please monitor for vomiting, diarrhea, not eating, tremors. If you notice any of these signs or have concerns, please contact ER or your vet
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