4/9/2026

DVM Intake Exam Estimated age: approx 3-7 years based on dentition Microchip noted on Intake? scanned negative History: agency Subjective: BAR Observed Behavior - hard barking in kennel, brought out sedation but p was friendly upon opening kennel door, allowed for all handling and tasks, solicits belly rubs and pets 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: moderate wear and staining to visible dentition with scant calculus PLN: No enlargements noted H/L: NSR, NMA, CRT < 2, Lungs clear, eupneic ABD: Non painful, no masses palpated U/G: MI, two scrotal testes MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Assessment: Dental dz- appears mild from visible dentition Prognosis: good Plan: intake exam and tasks awaiting sort SURGERY: Okay for surgery: Y

4/12/2026

Sick exam History: Intermittent V reported for 3 days, persistent V as of this AM. V/D in kennel, anorexic this AM. Crouched in back of kennel and difficult to coax out. Mild frank blood in kennel, unclear if in V or D. Subjective: QAR - tense and whale eye but tolerant when going slow with touch gradients, warmed up as exam progressed pink tacky MM, CRT ~2s Objective: P = 100 bpm R = 32 rpm BCS 3/9 EENT: Eyes clear, ears clean, no nasal or ocular discharge noted Oral Exam: Moderate staining of dentition, limited oral exam dt behavior PLN: No enlargements noted H: NSR, NMA, SSPPs L: Mildly increased BV sounds L cranioventral thorax, no crackles or wheezes, RR/RE WNL ABD: Tense, P tensing / flinching for cranial abdominal palpation, unable to palpate deeply due to pain U/G: MI - two symmetrical scrotal testicles MSI: Ambulatory x 4, skin free of parasites, no masses noted, moderate crusting of ventral scrotum CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Not performed, perianal diarrhea staining present Assessment: V/D/A/cranial abdominal pain/weight loss (with hematemesis vs hematochezia) r/o foreign body vs infectious gastroenteritis (IPs vs bacterial vs viral) vs HGE vs pancreatitis vs stress vs dietary indiscretion vs food allergy vs other Increased BVs r/o stress vs early aspiration pneumonia vs other Approx 8% dehydrated r/o 2ary to GI losses Underweight Moderate FAS MI young adult mixed breed canine Prognosis: Fair Plan: ADMIT to medical ICU CBC/biochemistry IH SEDATED for radiographs - 0.4mL dexmedetomidine and 0.4mL methadone IM ~9:45AM - light sedation achieved 2 view AXR - Multifocal intraluminal SI and colonic gas shadowing present, ingesta in stomach with some gas and mild rounding of pylorus. AFAST performed - confirmed above, no overt obstruction seen, normal pyloric flush witnessed. Diffuse intestinal hypomotility (r/o artefact from sedation vs true) Otherwise NSF, no FF. Pancreas, R kidney and adrenals not visualized. CXR - Very mild diffuse bronchial pattern r/o chronic bronchitis (allergic vs infectious (bacterial vs parasitic vs other) vs other) vs other LRS 400mL SQ at time of exam Cerenia 2.1mL SQ at time of exam VitB12 0.25mL SQ at time of exam Antisedan 0.4mL IM for reversal - P observed until sternal ADD Panacur 50lb dose PO SID x5d --> 4/17 ADD Entyce 2.1mL PO SID x3d --> 4/15 ADD Proviable 1 capsule PO SID x10dd --> 4/22 ADD Metamucil 1/2 tbsp PO BID x10d --> 4/22 ADD Gabapentin 600mg (~28mg/kg) PO BID x10d --> 4/22 (for analgesia), then continue long term for FAS ADD LRS 400mL SQ BID x2d --> 4/14 if able (OK to start on 4/13 since P received already today) If respiratory symptoms develop consider repeat CXR vs empirical antibiotic course DVM recheck 4/13 - if P eating consistently consider switch to GI diet

4/12/2026

Bloodwork interpretation CBC- unremarkable Mild lymphopenia (0.78K L) / eosinopenia (0.01K L) and moderate monocytosis (3.86K H) r/o partial stress leukogram Mildly decreased MCH (20.4L) HcT WNL, so little clinical significance Attempted to run chemistry multiple times with multiple samples - creat, phos, and cholesterol wound not read Biochemistry - Moderate BUN elevation (90H) r/o pre renal vs renal vs post renal azotemia Mild hyponatremia (130L) and hypochloremia (93L) r/o GI fluid losses vs other Mild hyperproteinemia (9H) / hyperglobulinemia (5.1H) r/o inflammatory vs infectious vs other Mild ALT (295H) / marginal GGT elevation (12H) r/o inflammatory / reactive vs 1ary hepatobiliary disease (cholestatic disease vs infectious vs inflammatory vs other) (no overt echogenic abnormalities on AFAST) Marginal hyperbilirubinemia (1H) r/o pre hepatic (hemolysis vs other) vs cholestatic disease (extrahepatic vs intrahepatic) Consider repeat biochem 4/13-4/14 If not electrolyte imbalance not improving with LRS consider switching to 0.9% NaCl If azotemia persists when euhydrated consider UA to idexx

4/12/2026

Staff note large amount of hematochezia / tenesmus On brief assessment P QAR, tensing and turning for cranial abdominal palpation ADD Metronidazole 250mg (~12mg/kg) PO BID x5d --> 4/17 ADD Top up dose 0.4mL methadone IM CPV SNAP - negative CWCP, DVM recheck 4/13

4/13/2026

recheck, V/D/A with hematochezia S/O QAR, noted to have fallen over when tried to take out for walk, noted to be very lethargic, food untouched, hematochezia present in kennel, meds appear untouched. Turned onto his side and stayed there for exam, only getting up to have another episode of hematochezia, then back to laying on his side T: 99.5 P: 130 R: 32 *note: taken after starting on shock bolus EENT: no ocular or nasal dc, mm hyperemia, tacky >3 second, inner side of gums noted to appear hyperemic, no petechiae present HL: nma, clear bilaterally, noted to initially appear tachycardic and tachypneic- set up on shock bolus, mild increase in respiratory effort that resolved when receiving fluids and methadone, PSS GA/GU: guarding abdomnen MSI: able to ambulate but prefers to be sternal or lay lateral, prolonged skin tent A. Hematochezia - acute Anorexia Dehydration mildly shocky P. Repeat in house BW IVC + IVF: start with 1/4 shock bolus + 5% dextrose over 15 min, then to 2x maintenance. To recheck blood work +/- additional 1/4 shock bolus this afternoon Cerenia 1mg/kg slowly IV SID x 3 days (2m,L Unasyn 15mg/kg slowly IV B-TID (as time allows) x 3 days (10.4mL) Methadone 0.2mg/kg IV B-TID (pending alertness and unasyn 15mg/kg IV Continue with entyce, offering bland diet- can syringe feed once p is more alert and sternal Brief recheck and TPR assessment q 1 hour during the day If p not stable by EOD, rec sending offsite for o/n monitoring, fluids, pain control and return in the AM

4/13/2026

CBC results: HCT H normal (52) H monos (4.07) eos (0.02) CHEM: BUN > 130 (increased from yesterday, 90) Ph H (11.1) NA L (116, decreased from yesterday 130) H K (6.6) L Cl (81 H ALT (191) improved from yesterday A. H BUN- increased from yesterday r/o pre-renal, hypoperfusion, dehydration H Ph r/o decreased perfusion (creat did not run despite multiple attempts on catalyst) L Na with high K : r/o GI losses vs addisonian va acidosis H ALT - r/o decreased perfusion vs primary hepatopathy P. Changed fluid to 0.9% NaCl Short acting insulin not available - to recheck blood and potassium in another hour. Give calcium glucaonate if needed To repeat bolus. Careful monitoring throughout the day - hyperkalemia. P on the borderline of when cardiac changes can occur. If tolerant, to perform EKG with additional blood and bolus with afternoon recheck

4/13/2026

Addendum: Noted to appear more alert, given an additional 1mL dex SP IV. Noted to be up and alert, walking a few steps but unsteady. Given another bolus 325mL (total 1500mL), blood work re-run, awaiting results BW results: Creatinine too high to read (due to previous blood machine errors unknown too high to read and believe broken earlier as other values missing). BUN 113 (decreased) Na (increased) K 6.9 (increased). Disc with 1657 to hold off insulin for now and fluids changed to LRS for remainder of day to reduce chance of dextrose acting as osmotic agent. Possible AKI if creatinine and BUN dont improve with continued fluids therapy - r/o primary vs severe pre-renal azotemia second to poor perfusion.

4/13/2026

Lepto ELISA sent to lab. Urine on hold in fridge in lab

4/13/2026

Brief PM recheck P at back of kennel and gives a low growl when approached - unable to lift lips to assess mm Eyes not sunken and P reportedly brighter / was out and able to walk. Cap IVFT overnight Restart IVFT first thing in AM - 0.9% NaCl with 5% dextrose @104mL/hr AM DVM recheck

4/14/2026

Progress exam Subjective: BAR - growling in kennel but loose body language and soliciting attention with female DVM, P more wary of male staff pink dry MM, CRT ~2s, prolonged skin tent P has fair appetite when eating high value foods outside kennel No stool or V in kennel overnight no c/s/v/d reported Objective: P = 96 bpm R = 24 rpm BCS 3/9 EENT: Moderate episcleral injection OU, ears clean, no nasal or ocular discharge noted Oral Exam: Moderate staining of dentition as prior PLN: No enlargements noted H: NSR, NMA, SSPPs L: Mildly increased BV sounds L cranioventral thorax, no crackles or wheezes, RR/RE WNL ABD: Soft, nonpainful, no palpable masses U/G: MI - two symmetrical scrotal testicles MSI: Ambulatory x 4, skin free of parasites, no masses noted, moderate crusting of ventral scrotum CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal: Not performed, perianal diarrhea staining present Assessment: V/D/A/cranial abdominal pain/weight loss/collapse (with hematemesis vs hematochezia) - clinically improving r/o Addisonian crisis vs infectious (leptospirosis vs other) vs 1ary GI (HGE vs pancreatitis vs other) vs other Increased BVs - not appreciated today Approx 10% dehydrated - mild improvement Underweight Moderate FAS MI young adult mixed breed canine HX low Na/K ratio r/o addisonian vs artefact / hemolysis vs other HX severe azotemia r/o AKI (underlying cause open) Prognosis: Guarded Plan: Leptospirosis ELISA - NEGATIVE - lepto unlikely @tt CONTINUE IVFT 0.9% NaCl w 5% dextrose @104mL/hr (~2x maint) EXTEND Cerenia 1mg/kg IV --> 4/16 EXTEND / INCREASE Unasyn to 20mg/kg slow IV BID --> 4/16 ****4/16 IS 4th DAY OF IVC - EITHER REMOVE OR REPLACE**** Midday DVM recheck Lepto PCR pending Repeat CBC/biochemistry IH ADD baseline cortisol to IDEXX to r/o addisons disease -- consider ACTH stim with placement (cortrosyn not available in shelter) Can try to restart PO medications as previously RXd @tt

4/14/2026

Set up on IV fluids (0.9% NaCl and 5% dextrose at 100 ml/hr). // Completed

4/14/2026

Bloodwork interpretation CBC - Monocytosis (3.29K H) persists Eosinopenia (0.04K L) persists Severe thrombocytopenia (27K L) - NEW r/o consumption vs destruction vs sequestration vs artefact re clumping vs other Biochemistry - HX Azotemia - RESOLVED HX Hyperphosphatemia (11.1H) --> now hypophosphatemia (2.1L) r/o GI loss +/- fluid admin vs other HX hyponatremia (116L) --> improved (139L) not resolved Hyperkalemia - RESOLVED HX hypochloremia (81L) - improved (102) not resolved HX elevated ALT (191) --> improved (127H) not resolved Na/K ratio - improved (37N) Baseline cortisol submitted / pending CWCP - monitor closely for signs of spontaneous bleeding (petechia / ecchymosis), consider repeat BW in 24-48hrs

4/14/2026

P V bile with cheese despite cerenia ADD Ondansetron 0.5mg/kg slow IV BID --> 4/15

4/14/2026

OK to cap fluids overnight, P subjectively brighter and is kinking fluid line DVM recheck 4/15

4/15/2026

Recheck S/O: QAR-BAR (brighter out of kennel), not eating, not eating meds, bright yellow liquid in water bowl (presumed vomit), brown/red wet stain on bedding (presumed diarrhea/hematochezia), no c/s noted EENT: No ocular or nasal discharge LUNGS: Eupneic MSI: Ambulatory x 4, underweight, mild skin tent CNS: Appropriate mentation A: Anorexia Vomiting through cerenia Diarrhea, hematochezia Dehydration Hx of acute lethargy/collapse HX severe azotemia - resolved Hx of electrolyte abnormalities - largely resolved on most recent bw Prognosis: Guarded P: Repeat bloodwork today - sent to lab Discontinue most oral meds since not eating them - psyllium husk, gabapentin, panacur Continue IV fluids - LRS @ 100ml/hr today, d/c overnight Continue cerenia and unasyn Recheck tomorrow

4/15/2026

Continues to vomit and have inappetence reviewed initial rads: possible suspicious area in in cranial abdomen Repeat Radiographs: Dog sedation: no obvious FB; decreased detail r/o weight loss; no ingesta in stomach or colon Using 0.8 ml dexmedetomidine at 500mcg/m2 (500mcg/ml) and 0.8 ml butorphanol at 0.4 mg/kg (10mg/ml) IM Reversed with Antisedan-0.8 ml IM

Upon intake dog was friendly and outgoing despite being fearful at first. He was easily leashed and placed in kennel but was not collared or scanned due to after hours pct intake.