Someone has a Shih Tzu puppy. Was fine, then started hacking or coughing eventually started throwing up. And now pretty much lethargic. They have taken him to the vet has had numerous x rays no blockages,done parvo test and it was negative. The vet is giving him fluids. But the vet is stumped on what it could be. If anyone has any ideas please let me asap . The puppy is very sick Maybe a poisoning of some kind ? Please any ideas would help

Is this a real dog you are asking about, or is this a vet tech test question?

Second opinion may be warranted.

I doubt this is a vet tech test question.

Coughing and hacking and coughing to the point of vomit could be a lot of respiratory things. Pneumonia would definitely cause the hacking and coughing.. and not feeling well period would make the puppy lethargic.

Maybe the x-rays need to be taken higher up on the body instead of just focusing on the abdomen.