3/20/2025

DVM Intake Exam Estimated age: 10 yr Microchip noted on Intake? negative History:stray Subjective:stray Observed Behavior -friendly and docile Is there evidence of Cruelty?none Is there evidence of Neglect?none Is there evidence of Trauma?none Objective BAR moderate dehydration P = WNL R = WNL BCS 3/9 EENT: Eyes nuclear opacity, ears clean, no nasal or ocular discharge noted Oral Exam: diffuse moderate tartar, mm pale pink, tacky PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupnic ABD doughy U/G: neutered, moderate sized bladder MSI: Ambulatory x 4, skin free of parasites, no masses noted, rough haircoat, scattered matting, lots of dander CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: not performed Assessment pu/pd geriatric, underweight dehydrated acute vs chronic RF excellent appetite embedded nails matted anemia hyperphosphatemia azotemia hypernatremia Prognosis: guarded Plan: CBC HCT 21.5%, NEUT 23.88 chem CREAT 2.9, BUN 86, bili 1.2 lytes phos 12.4, Cl 131, Na 176 T4 normal groomed most of mats out Deadline of 2 days IV catheter start IV fluids 20ml/ hr baytril 4 mg/kg IV SID x 10 days famotidine 1 mg/kg SC

3/21/2025

Recheck CKD S/O: QAR, allows all handling Good appetite, ate well overnight No c/s/v/d noted EENT: Mild mucoserous discharge OU, no nasal discharge LUNGS: Eupneic MSI: Dorsal muscle wasting, underweight; dull haircoat with significant skin tent CNS: Appropriate mentation USG: 1.014 A: Underweight, DMW Poor haircoat, embedded claws PU/PD Non regenerative anemia Neutrophilic leukocytosis Azotemia, hyperphosphatemia, low USG - kidney disease, rule out chronic vs acute on chronic Hypernatremia, hyperchloridemia - ro CKD +/- dehydration Hyperbilirubinemia - ro hepatopathy vs hemolysis vs artifact vs other Prognosis: guarded P: Continue IV LRS @ 20 ml/hr Collect urine for USG and UA Okay to d/c famotidine and enrofloxacin Seek placement ASAP for continued hospitalization

3/22/2025

Recheck, UA results S/O: BAR at front of kennel this morning, great appetite; IV pump beeping/not running this AM No c/s/v noted, soft stool and diarrhea in litterbox FS ranging 5-6 EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Dull haircoat, skin tent improving CNS: Appropriate mentation UA: USG 1.011, pH 6.0, trace proteinuria, trace blood/hemoglobin A: Diarrhea - ro dietary (offered many HV foods in past 2 days) vs other CKD - azotemia, hyperphosphatemia, low USG Underweight, DMW Poor haircoat, embedded claws PU/PD Non regenerative anemia Neutrophilic leukocytosis Hypernatremia, hyperchloridemia - ro CKD +/- dehydration Hyperbilirubinemia - ro hepatopathy vs hemolysis vs artifact vs other P: Flushed IV line and continue IV LRS @ 20 ml/hr Discontinue IV fluids at EOD today Recheck and consider switching to SQF tomorrow Removing deadline due to consistently good appetite. Seek placement for continued care of chronic kidney disease - additional diagnostics and treatment plan with veterinarian vs palliative care options.

3/23/2025

recheck CKD kitty S/O QAR, comes to the front of the kennel, no c/s/v/d noted or appreciated today, food tray emptied, water bowl emptied- refilled and start drinking asap EENT: no ocular or nasal dc HL: eupneic MSI: slight delay in skin turgor, amb x 4 A. CKD D+- none appreciated today P. Change to SQF 100mL SID x 3 days CTM in medical and recheck in 3 days, p will likely need ongoing fluid therapy for kidney disease Con't to seek placement, p will need ongoing care for renal disease

3/25/2025

Brief recheck S/O: BAR at front of kennel Great appetite, vomit on bedding; no c/s/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic A: Vomit x 1 CKD - azotemia, hyperphosphatemia, low USG Underweight, DMW Poor haircoat, embedded claws PU/PD Non regenerative anemia Neutrophilic leukocytosis Hypernatremia, hyperchloridemia - ro CKD +/- dehydration Hyperbilirubinemia - ro hepatopathy vs hemolysis vs artifact vs other P: Continue SQ LRS, monitor for further vomiting CTM in ICU, seek placement for continued careof chronic kidney disease

3/27/2025

Recheck CKD, on SQ LRS SID S/O: BAR at front of kennel, eating very well No c/s/v/d noted EENT: No ocular or nasal discharge LUNGS: Eupneic CNS: Appropriate mentation CBC: Hct 18.5 (30.3-52.3), platelets 55 (plt aggregates detected, likely higher count than reported) CHEM: Creatinine 2.4 (0.8-2.4), BUN 48 (16-36) PCV/TS: 25%/6.6 A: CKD - azotemia, hyperphosphatemia, low USG Previous vomit/diarrhea - not noted today Underweight, DMW Non regenerative anemia Neutrophilic leukocytosis - resolved Hypernatremia, hyperchloridemia - resolved Hyperbilirubinemia - resolved P: Recheck in house bw today - improvement in azotemia Okay to discontinue SQF administration for now, may require regular administration with placement CTM closely in ICU, seek placement ASAP for continued/longterm care of chronic kidney disease