A 28-Year-Old Writer With Bilious Vomiting After Egg Donation

Richard Lucidi, MD; Jordan Hylton, DO

Disclosures

May 28, 2021

Physical Examination and Workup

Upon physical examination, the patient appears slightly lethargic. She has a temperature of 102.74°F (39.3°C). Her pulse is 123 beats/min. Her blood pressure is 125/72 mm Hg.

Head and neck findings are normal. Lung auscultation reveals normal breath sounds throughout bilaterally, without wheezes or crackles. The patient's heart sounds are tachycardic but regular, and no murmur is appreciated. Abdominal examination reveals a soft, diffusely tender abdomen without rebound or guarding. No peripheral edema is noted. Peripheral pulses are palpated and equal bilaterally.

Laboratory analysis, including a complete blood cell count and a complete metabolic panel, reveals the following:

  • White blood cell count: 14.4 x 103 cells/µL (reference range, 4-11 x 103 cells/µL)

  • Neutrophils: 92.1% (reference range, 55% to 70%)

  • Albumin level: 3.1 g/dL (reference range, 3.4-5.4 g/dL)

  • Sodium level: 134 mEq/L (reference range, 135-145 mEq/L)

  • Chloride level: 112 mmol/L (reference range, 96-106 mmol/L)

Other laboratory values are within normal limits, including a negative result on a urine pregnancy test. Urine, stool, and blood cultures are obtained. A chest radiograph is unremarkable. Transvaginal ultrasound (TVUS) is performed (Figure 1).

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