Case Report
A 45-year-old man presented to the emergency department with four episodes of vomiting of ingested food. It is non bilious, non-projectile and does not contain blood. He has periumbilical non-radiating abdominal pain with gradual onset of 3 days duration. He was previously diagnosed with mild duodenitis via endoscopy, for which he had initiated treatment with oral Esomeprazole 40mg per day for a month. The patient’s medical history was otherwise not noteworthy. His family history was noncontributory. He occasionally drinks 2 units of alcohol but has no history of drug use or smoking.
On admission, he had a body temperature 36.4 °C, a blood pressure of 120/80 mmHg, a respiratory rate of 16 breaths/min, a heart rate of72 beats/min, and an oxygen saturation of 95% of room air. On physical examination, we noticed the patient had dry mucosa and mild epigastric tenderness. His cardiovascular and respiratory examinations were normal. Results of his abdominal examination was normal and he had no lower-extremity edema. A summary of his laboratory investigations are reported in Table 1. A baseline ECG was obtained, which showed a normal sinus rhythm with non-ischemic changes. His cardiac troponin T levels was initially 2.8ng/dL.