28-Year-Old Man With Nausea, Vomiting, and Diarrhea

Nicolas Grundmann, MD, MBA


June 10, 2015

Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 28-year-old man presents to the emergency department with 8 hours of nausea, vomiting, and diarrhea. He states that the emesis is not bloody or dark green. The stool consists mainly of watery fluids and mucus without blood (Figure 1). He has had more than six bowel movements in the past 8 hours and is unsure how many times he has vomited, simply stating "a lot." He reports that he cannot eat any food or drink liquids without vomiting.

On questioning, the patient has no significant medical history and takes no medication. He denies recent travel, camping, or antibiotic use. He claims that this has never happened to him before. He has taken no medications to help his symptoms and reports no allergies.


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