After Drinking 21 Beers, a 27-Year-Old Can’t Stop Vomiting

Gerard J. Fitzmaurice, BSc, MBBCh BAO; Robin Brown, MD, FRCS; Mark E. O'Donnell, DSEM, MFSEM, MRCS; Fionnuala Mone, MBBCh BAO; Angela McGreevy, MBBCh BAO


November 30, 2021

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 that you would like to suggest for a future Case Challenge, please contact us.


A 27-year-old man presents to the emergency department with a 2-day history of hyperemesis followed by episodes of hematemesis. He is experiencing worsening epigastric pain, diarrhea, and myalgia. The patient also describes night sweats and rigors. No melena or hematochezia is reported.

The patient is a binge drinker and consumed approximately 21 cans of beer 3 days ago. The patient's relevant medical history includes esophagitis, which was diagnosed last year and was treated with a long-term proton pump inhibitor. He has no known drug allergies and has not taken any other medications recently. He does not use any illegal substances.

He has a significant family history of hypertrophic obstructive cardiomyopathy. He works as a laborer and has smoked 10 cigarettes a day for the past 6 years. Soon after presenting in the emergency department, the patient collapses.


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