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

Nicolas Grundmann, MD, MBA

Disclosures

June 10, 2015

Physical Examination and Workup

Upon examination, the patient appears uncomfortable. He states that he feels like he is going to vomit again. Relevant findings are as follows:

  • Blood pressure: 130/85 mm Hg

  • Heart rate: 95 beats/min

  • Respiratory rate: 18 breaths/min

  • Oral temperature: 98.3°F

  • Oxygen saturation: 94% on room air

  • Point-of-care fingerstick: Normal

An evaluation of the patient's head, ears, eyes, nose, and throat reveals only dry mucus membranes. A cardiovascular examination reveals low-grade tachycardia with a regular rhythm and normal S1 and S2 sounds. No murmurs, rubs, or gallops are noted. Upon pulmonary evaluation, clear breath sounds are heard bilaterally, with no wheezes or crackles.

Evaluation of the abdomen reveals hyperactive bowel sounds, very mild diffuse tenderness that does not localize to any one area, and a negative Murphy sign, with no guarding or rebound. Pressing deep in the epigastric area makes the patient nauseous. No skin rashes are found.

A basic chemistry panel is ordered, and an intravenous line is started for fluid administration.

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