ABSTRACT
History and examination A 30-year-old man arrived in A&E with a 1-week history of severe vomiting. He had been taking antacids for dyspepsia for some time, but this week the antacids did not seem to be working. He had been unable to ‘keep even fluids down’ and was feeling rather faint and unwell. On examination, he showed epigastric discomfort, his pulse was 100 beats per minute and blood pressure (BP) 110/65 mmHg, and he was afebrile.
