Methocarbamol Case Details Submission Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please note, for multiple submissions, the form will save entry details for auto population Contact Details Vet Name *FirstLastClinic Name *Best Contact Number *Email *Patient Details Species *--- Select Choice ---Canine (Dog)Feline (Cat)Equine (Horse)OtherIf Other Species, please specifyAge (Years) *Sex *Male NeuteredMale IntactFemale SpayedFemale IntactBreed *Weight (estimated) in kg *Symptoms (e.g. tremors, hypersalivation, seizures, etc) *Preliminary Diagnosis *--- Select Choice ---Toxicity (tetanus)Toxicity (metaldehyde)Toxicity (pyrethroids)Toxicity (strychnine)Toxicity (CNS stimulants – caffeine, amphetamine, guarana)Toxicity (SSRI)Toxicity (macrocyclic lactones)Toxicity (tremorgenic mycotoxin or compost/garbage ingestion)Toxicity (isoxazaline)Toxicity (plant)Toxicity (1080)Intracranial/head traumaSteroid responsive tremor syndromeMeningitisMusculoskeletal disease (intervertebral disc syndrome)Musculoskeletal disease (spinal cord injury)Musculoskeletal disease (sprain, strain or soft tissue inflammation)Musculoskeletal disease (rhabdomyolysis/tying-up)Perioperative (manage muscular spasms)Seizures (unknown cause)UnknownOtherIf Other or Unknown Preliminary Diagnosis, please specifyDate / Estimated Time Methocarbamol first administered? *DateTimeAny other relevant informationMethocarbamol dose rate (DAY 1) 1st dose in mls *2nd dose in mls3rd dose in mls1st Dose Route of Adminstration *--- Select Choice ---IV (bolus)SCIMCRIPO2nd Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPO3rd Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPOMethocarbamol dose rate (DAY 2) 1st dose in mls2nd dose in mls3rd dose in mls1st Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPO2nd Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPO3rd Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPOMethocarbamol dose rate (DAY 3) 1st dose in mls2nd dose in mls3rd dose in mls1st Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPO2nd Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPO3rd Dose Route of Adminstration--- Select Choice ---IV (bolus)SCIMCRIPOOther medications administered Drug name 1Drug name 2Drug name 3Drug name 4Drug name 5Drug 1 Dose in mlsDrug 2 Dose in mlsDrug 3 Dose in mlsDrug 4 Dose in mlsDrug 5 Dose in mlsDrug 1 Dose Time AdministeredDrug 2 Dose Time AdministeredDrug 3 Dose Time AdministeredDrug 4 Dose Time AdministeredDrug 5 Dose Time AdministeredDrug 1 Frequency (e.g once, BID)Drug Frequency 2 (e.g once, BID)Drug Frequency 3 (e.g once, BID)Drug Frequency 4 (e.g once, BID)Drug Frequency 5 (e.g once, BID)Adverse reactions to methocarbamol (if any e.g. CNS depression, etc) *--- Select Choice ---NoneLethargy/sedation/depressionVomitingAtaxiaAnaphylaxisSudden deathOther (please specify) belowIf Other Adverse reactions please specifyWas the animal administered methocarbamol to treat signs of tremors? *YesNoIf yes, please choose a response that best describes what you noticed immediately after methocarbamol was administered:Condition deteriorated/tremors worsenedNo change in tremorsSmall improvement in tremors, but further treatment requiredSignificant improvement in tremors, but further treatment requiredSignificant improvement in tremors, no further treatment requiredComplete resolution of tremorsOutcome *--- Select Choice ---DiedEuthanased (financial limitations)Euthanased (poor response to treatment)PendingRecoveredTransferred to another clinicTime to recovery *--- Select Choice ---<1h1-3h3-6h6-12h12-24h24-48h>48hDid not recoverAny other relevant informationSubmit
