En mann i 30-årene med residiverende oppkast og magesmerter lindret av varm dusj

Abstract

A man in his 30s was admitted to the medical ward with nausea, retching, vomiting and abdominal pain. Seven years previously he had been admitted with stabbing retrosternal pain that worsened with intake of food and drink. At that time a small hiatus hernia of 1 – 2 cm and a small protrusion down towards the Z line were demonstrated. Over the following years the patient was admitted several times with corresponding symptoms. During the last admission it appeared that he smoked marijuana once a week. On examination on admission the patient had epigastric pain, he was sweating, felt nauseated and vomited green fluid. He had a lean stature. His blood pressure was 140/ 90 mm Hg, pulse 48 and the temperature measured in his ear was 35.4 °C. There was slight tenderness on light palpation in the epigastrium. There was no diarrhoea, he had had a normal bowel movement the same morning. His medication was pantoprazole 40 mg  1. He had smoked marijuana on the day before admission. Pantoprazole infusion was started. He had metabolic acidosis with base excess (BE) – 9.0 mmol/l (–3 – 3 mmol/l) and lactate 5.1 mmol/l (0.5 – 2.2 mmol/l) but the circulation was not affected. Blood tests showed a haemoglobin of 17.7 g/100 ml (13.4 – 17.0 g/100 ml), leukocytes 12.9  109/l (3.7 – 10.0  109/l), potassium 4.9 mmol/l (3.5 – 4.4 mmol/l) and glucose 8.4 mmol/l (4.2 – 6.3 mmol/l). The serum ethanol was negative.