Species: dog
Breed: Beagle
Sex: f, neutered
Weight: 16.2 kg
Birth date: 2014-10-21 00:00:00
Primary diagnosis: Enteropathy, aspiration pneumonia, pancreatitis, polynervitis N. facialis & N. vestibulocochlearis on both sides, (vestibular syndrome, mitral valve endocardiosis, hypothyroidism)
Situation: emergency follow-up
Time since surgery: 2-4 hrs
Medical history: Kuma was presented to our clinic on 13.11.2024 due to acute vomiting. She started vomiting around 4:00 that night, pieces of food were in her vomit. The next time she vomited was around 7.00 am, from then on it was more like saliva, bloody, transparent liquid, the owner spoke of bile. Over the course of the day it was about 10 times, always small amounts. It is possible that Kuma ate a piece of wood that night (husband made a fire). The dog is also known to have vestibular syndrome, the symptoms are better but not gone, she still holds her head at a slight angle and walks ataxically and she has difficulty closing her right eye. The dog is on Prednisolon PO since the 15.10.2024 (for 2 weeks 20 mg PO SID, then slowly reduced, unknown dosis right now), together with Omeprazol 20 mg/kg PO SID. The dog has also a known hypothyroidsm and mitral valve disease. In 2020 she had an IVDH at C2/3 and unterwent surgery (ventral slot). She was given painkillers by the private vet on the day of presentation (unknown what and in what dosis). Wehn Kuma was presented to us, she was breathing badly because of an aspiration pneumonia, therefore she was stabilized with oxygen high flow. On 14.11 an abdominal ultrasound was performed but had to be suspended due to Kuma's clinical state. Ultrasound report 14.11: Segmental jejunal enteropathy; Diffuse mild hepatopathy --> Segemental enteropathy DDx: subileus, segmental ischemia, segmental neuromuscular dysfuntion; Hepatopathy is unspecific DDx: vacular hepatopathy, hypercorticocism, fatty infiltration, less likely round celll infiltration. On 15.11 another abdominal ultrasound was perfomerd --> report: Regressive segmental enteropathy; New mild to moderate peripancreatic steatopathy --> Peripancreatic steatopathy indicating pancreatitis, primary vs. secondary. On 18.11 they performed another abdominal ultrasound - report: Resolved segemental enteropathy and peripancreatic steatopathy; Static mild diffuse hepatopathy --> Hepatopathy is unspecific DDx: vacular hepatopathy, hypercorticocism, fatty infiltration, less likely round celll infiltration. On 19.11 the oxygen supplementation was stopped and on 22.11 Kuma went home.
Medication: Before presentation: Prednisolon PO SID (last time the evening before?), Omeprazol 1.2 mg/kg PO SID (last time?). Before observation 1: Methadon 0.2 mg/kg IV, Ondansetron 0.3 mg/kg IV. Before observation 2: Ampicillin 30 mg/kg IV. 13.11 started/continued after observation 2: Methadon 0.2 mg/kg IV q4h, Ondansetron 0.3 mg/kg IV TID, Ampicillin 30 mg/kg IV TID, Gabapentin 10 mg/kg PO TID, Levothyroxin 12 µg/kg (200 µg) PO BID. 14.11: Methadon & Ondansetron & Ampicillin & Gabapentin (given after observation 3) & Levothyroxin (given after observation 3) same as on 13.11, Maropitant 1 mg/kg IV. 17.11: switch frm Buprenorphin 0.015 mg/kg IV to Methadon 0.2mg/kg IV q4h, Paracetamol 10 mg/kg IV TID, Maropitant 1 mg/kg IV SID, Ondansetron 0.5 mg/kg IV TID, Ampicillin 30 mg/kg IV TID, Gabapentin 10 mg/kg po TID, Trazodon 10 mg/kg PO at 24 (probably also at 14 and 16 but dosis unclear), Levothyroxin 20 µg/kg (320 µg) PO BID, Metoclopramid CRI 2 mg/kg/d IV, Cisaprid 0.5mg/kg PO TID. 18.11 (nothing given before observation 5): Methadon & Paracetamol & Maropitant & Ondansetron & Ampicillin & Gabapentin & Levothyroxin same as on 17.11, Trazodon 10 mg/kg PO TID, Metoclopramid CRI 1 mg/kg/d IV, Cisaprid 1 mg/kg PO TID, Metamizol 30 mg/kg IV TID started at 17, Omeprazol 1 mg/kg IV BID. 19.11: Metamizol & Paracetamol & Maropitant & Ondansetron & Ampicillin & Gabapentin & Levothyroxin same as on 18.11, Metoclopramid CRI 2 mg/kg/d, Methadon 0.2 mg/kg IV 1x at 09 then stopped, Trazodon 15 mg/kg PO TID, Cisaprid 1 mg/kg PO/rectally TID, Sucralfat 2.5 ml PO TID, Acepromazin 0.01 mg/kg IV 1x around 10, Ketamin 1 mg/kg SC 1x at 10. 20.11 (everything given before observation 8): Paracetamol 10 mg/kg IV BID, Ondansetron 0.5 mg/kg IV TID, Omeprazol 1 mg/kg IV BID, Ampicillin 30 mg/kg IV TID, Gabapentin 10 mg/kg PO TID, Levothyroxin 20 µg/kg (320 µg) PO BID, Metoclopramid CRI from 1 mg/kg/d to 0.5 mg/kg/d and stopped at 17, Cisaprid 1 mg/kg PO BID, Maropitant 1 mg/kg IV SID, Metamizol 30 mg/kg IV TID, Lactulose 2 ml at 09, Sucralfat 2.5 ml PO TID. 21.11 (nothing given before observation 9): Levothyroxin & Cisaprid & Sucralfat & Lactulose same as 20.11, Metamizol 30 mg/kg PO TID, Paracetamol 10 mg/kg PO TID, Omeprazol 1 mg/kg PO BID, Cylanic 234 mg (Amoxicillin 12 mg/kg & Clavulanic acid 3 mg/kg) PO BID. 22.11 (nothing given before observation 10): Metamizol & Cylanic & Levothyroxin & Cisaprid & Paracetamol & Sucraöfat & Omeprazol & Lactulose same as 21.11.
Pain type: acute, inflammatory, visceral
Pain origin: thorax, abdomen
Pain duration: Less than 24 hours
Estimated pain severity: 56