7/19/2026

DVM Intake Exam Estimated age: approx 10 weeks based on dentition and conformation Is this an orphan kitten? N Is the kitten eating on own? Y Is the kitten suckling? N Microchip noted on Intake? scanned negative History: os - per admissions prior o stated that p was suspected to have congenital liver shunt, no records Subjective: BAR Observed Behavior - alert and active, purring, solicits attn Is there evidence of suspected cruelty? N Objective: T = np P = wnl R = wnl BCS 4.5/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: adult incisors starting to erupt, deciduous dentition otherwise PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: FI MSI: Ambulatory x 4, lice eggs, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Wood's Lamp Exam: negative Assessment: Weaned kitten Lice Hx of possible liver shunt Prognosis: guarded - fair pending BW Plan: intake exam and tasks capstar selarid CBC/CHEM to lab- check for results tomorrow seek placement - if p has congenital liver shunt will need further diagnostics/work up than available in shelter awaiting sort SURGERY: Okay for surgery: Y, pending BW results

7/20/2026

Blood work results: CBC: L HCT (29.5) H Retic (102) CHEM: L creat (0.8) H Phos (9.2) - age L TP (5.9) r/o production, losses L globulins (2.5) r/o production, losses, age, artifact sl H ALP r/o spurious vs open A. mild regenerative anemia P. BW completed at offsite prior to intake shows H NH3 (227, ref range 0-95), low BUN (13) and p noted to be obtunded on admit and responded well to lactulose enema, lactulose and supportive care. Suspicious for congenital porto-systemic shunt vs defect in urea cycle vs open. Start lactulose 0.5mL PO BID TFN in care Seek placement- will need internal medicine work up (AUS, bile acid testing) house in ICU when space allows with seizure watch signage recheck in 2 days

7/20/2026

Brief recheck S: BARH - at front of kennel soliciting attention pale pink moist mm no c/s/v/d reported great appetite O: EENT: No ocular or nasal discharge, corneas clear LUNG: Eupneic at distance MSK: Ambulatory x4 INT: Healthy haircoat at distance CNS: Appropriate mentation, no neurologic abnormalities @tt A/P: Conditions as prior, CWCP, recheck in 48hrs, seizure watch, seek placement

7/22/2026

recheck suspected liver shunt kitten S/O BAR, A+A, excellent appetite, no c/s/v/d appreciated or noted EENT: no ocular or nasal dc HL: eupneic MSI: amb x 4, good skin turgor CNS: mentation appropriate, no neuro abn appreciated A. Weaned kitten Hx of H NH3 offsite and suspected congenital PSS P. Recheck in 2 days Con't to seek placement CTM while at QACC

7/24/2026

Recheck - came from outside vet; presented obtunded with elevated ammonia and low BUN, concern for liver shunt, responded to IV fluids and lactulose enema *No neurologic signs noted since intake at shelter S/O: BAR, active and playful, climbing kennel door; great appetite, no c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Amb x 4 CNS: Appropriate mentation A: Hx of obtunded mentation, elevated ammonia + low BUN - no clinical signs in shelter. Rule out transient episode (toxin vs other) vs congenital vs other P: Scheduled recheck bw Continue lactulose and CTM closely on rounds

7/25/2026

Blood collected and sent to Idexx reference laboratory. // Completed

7/26/2026

Progress, suspected PSS vs open S/O BAR, A+A, no c/s/v/d appreciated or noted, excellent appetite, comes to front of kennel for interaction and solicits attn EENT: no ocular or nasal dc, no oral lesions HL: eupneic MSI: amb x 4, good skin turgor A. Weaned kitten hx of elevated NH3 levels offsite, no neuro episodes in care reported P. Awaiting BW results- check for results tomorrow CTM and seek placement.

7/28/2026

Blood work results: CBC: sl L HCT (29.6) - same as 7/20 retics wnl (48) - decreased from 7/20 sl H monos (0.552) CHEM: Creat L (0.6) - decreased from 7/20 (0.8) H Phos (6.8) decreased from 7/20 (9.2) H ALP (125) increased from 7/20 (76) TT4 wnl A. Anemia without regeneration aTT pre-regen vs losses vs production L creatinine r/o age, potential PSS, artifact H Phos - young animal H ALP- r/o spurious vs primary MS vs hepatic (other LEs wnl) P. Con't with current tx plan Seek placement asap - p requires specialized diagnostic tests and further imaging to r/o suspected shunt by prior offsite vet prior to surrender. CTM while at QACC- recheck in 3 days