Clinical case:- Vomiting and dizziness in a 47-year-old male

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Vomiting and dizziness in a 47-year-old male

HISTORY OF PRESENT ILLNESS

A 47-year-old male with no significant medical history presented to the ED complaining of nausea, vomiting, diffuse abdominal pain, and dizziness with associated general body weakness for one day. He recently experienced a mild cough, runny nose and flu-like symptoms, as well as increased urination and thirst. He was found to be ataxic earlier that day by his primary care provider (PCP), and was urgently referred to the ED for further evaluation of a possible cerebellar stroke. The patient smoked cigarettes but denied drugs or alcohol. His family history was significant for hypertension. He took no medications.

PHYSICAL EXAMINATION

GENERAL APPEARANCE: The patient appeared acutely ill, was hyperventilating and had a fruity odor on his breath.
VITAL SIGNS
Temperature 95◦F (35◦C)
Pulse 110 beats/minute
Blood pressure 75/35 mmHg
Respirations 35 breaths/minute
Oxygen saturation 97% on room air
HEENT: PERRL, EOMI, oropharynx with dry mucous membranes.
NECK: Supple, flattened jugular veins.
CARDIOVASCULAR: Tachycardic, regular rate without rubs, murmurs or gallops.
LUNGS: Rales at the bases bilaterally, mild expiratory wheezes throughout.
ABDOMEN: Mildly distended, diffusely tender to palpation, hypoactive bowel sounds.
RECTAL: Normal tone, brown stool, hemoccult negative.
EXTREMITIES: Cool to touch, delayed capillary refill, weak peripheral pulses.
SKIN: Cool, pale and dry, no rashes.
NEUROLOGIC: The patient was somnolent but arousable, minimally followed commands, and was moving all extremities.

A peripheral intravenous line was placed and blood was drawn and sent for laboratory testing. A 12-lead ECG (Figure 1) and a portable chest radiograph (Figure 2) were obtained.

What is your diagnosis?



Figure 1 12-lead ECG from a 47-year-old male with dizziness, vomiting and abdominal pain



Figure 2 Portable chest radiograph from a 47-year-old male with
dizziness, vomiting and abdominal pain.

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[Liljana]

thanks for q

[XinYan]

Good question

[vahidny]

Thanks for this intriguing question.

[yamenshaer]

answer................