ABSTRACT
A 68-year-old man presented to the emergency department following an episode of collapse at home. He described a 4-day history of diarrhoea and vomiting. The diarrhoea was pale and watery with copious amounts of mucus. There was no fresh or altered blood in the stool. He was unable to quantify how frequently he was opening his bowels, responding with, ‘constantly’, whenever he was asked. He had been vomiting two to three times daily, usually after eating. He had been feeling light-headed for several hours until he lost consciousness upon standing. He awoke on the floor, feeling generally unwell but without any evidence of tongue biting or incontinence. His past medical history included type 2 diabetes mellitus, hypertension and hypercholesterolaemia. On direct questioning, he reported being constipated over recent weeks but had not used laxatives for this. He took 40 mg gliclazide BD and 20 mg simvastatin ON. He was a retired plumber and lived with his son. He was a current smoker of 10 cigarettes daily and had accumulated a 50 pack year history. He denied drinking alcohol or using recreational or herbal drugs. He had not travelled abroad for more than 5 years.
