Dog acting ill only at night

For the past four night, my four-year-old Dalmatian mix rescue has been acting strangely, primarily at nightfall. She is agitated, can’t find a place to settle down (whereas she usually sleeps in her own bed all night), she has vomited, jumps as if something is “getting her,” and appears to twitch and shake at times. We took her to the vet yesterday, where they opted to treat her for tick illness (bloodwork was normal). Her temp was 103.2 at the vet. Tonight she is licking her lips as if in pain, and running from place to place in our house once again. What could this be?? She seems almost entirely normal during the day. Nothing has changed in her environment. Could she be ingesting a toxin somehow?

Hello-  first off, thats a high temperature for a dog.  High temperatures can be due to infection, inflammation and / or pain amongst other things.  Lip licking can be down to pain or nausea and the movement you describe may be restlessness or pain.  I cannot promise that this isn't down to a toxin, but it seems unlikely that unbeknown to you, a dog (that has never behaved like this before), suddenly starts getting hold of a toxin and indulges only at night, every night.  I think it more likely that a patient has an underlying disease that intensifies at certain times eg in the hours after eating, or when they are bored with nothing to destract them.   Has pancreatitis been ruled out?  I ask because this also requires different blood tests to those most vets run on a machine.  It can be very painful.  Your vet may ask questions to rule neurological causes in or out.   A good question for your vet is, can you make me a list of all the things / sorts of things that could be causing this?  Then, 'which of these have we ruled out?'   Of the remainder, which are most common?  How would we rule those out?   Sometimes, diagnosing the patient has to take second place to helping them to cope ie keeping them well hydrated and controlling any pain.

Quickly I want to add: she seems to be avoiding sleep. She doesn’t want to lie down, and when she does it’s only for a few moments before she jumps up and runs to a new spot in our house. She’s been sitting in my bed for 15 minutes at 4:30am, not wanting to lie down. Pancreatitis has not been discussed. When she had tremors this evening her temperature was 100.4, but the vet leaned towards infection b/c of the previous fever (and because tick illnesses can present in a variety of ways). Basically that’s all that’s been addressed. I do think she’s in some sort of pain; it’s quite clear to me. I’ve wondered if it could be food-related (which was my thought in mentioning a toxin), but I can’t figure out why it wouldn’t also happen after breakfast.

Could she have pancreatitis with a normal appetite and very minimal vomiting? And no diarrhea to my knowledge? Just like so many diagnoses, parts of it really fit her and parts do not. She does seem to be arching her back. She does not want to lie down. A correlation to food seems plausible. Her lips are tacky, so she could be dehydrated. But she still wants to eat, and she’s only vomited once since this began four days ago.

Hello - absolutely, the pancreas can be inflamed and painful without persistent vomiting - and without a raised lipase from the old-fashioned blood profiles.  There are plenty other possible causes too - but I am not in a position to rule anything in or out; that's for your vet. My biggest concern right now however, would be that if she is 'taccy' and could be dehydrated, a drip might be indicated in the immediate term.  Perhaps this could be a good time for a chat to the vet about diagnostics.  Please will you let me know how she gets on?

I will. I’m texting the vet, but she quickly rejected pancreatitis because of the CBC.

This raises several interesting points. Your vet is in the best position to suggest and rule out diagnoses for your pet; they should by now have a handle on the clinical signs that they are most worried about.  Is the CBC one of them?  They can see the bloodwork and the patient, which I cannot.  This is why the mode of questioning that I have outlined (what are the main signs you are worried about?  What differentials (possible diseases) could cause these signs?  Which have you ruled out?  Which do you need to rule out?) will usually work the best with your vet.  If they say 'we've ruled this out because of X,' you can always ask how that rules the thing out if you are unsure.    Hopefully if your dog is taccy, they will be doing something to treat that.  I look fwd to hearing how things progress.