Clinical Case 120: Vomiting VBG

Gday – I am off on leave this month – so here is a quick case from the files.

It’s an unusual VBG.  I will tell you a few features on the history and you need to work out the diagnosis and tell me how you are going to manage this!

The patient is a 25 year old chap who presents with 2 main symptoms: intractable vomiting and the near obsessive need to shower – long hot showers.  He has presented today because the ondansetron wafers that his GP prescribed have not been helping with the vomiting and his hot-water system is not able to keep up his need for hot showers!

He certainly looks dry and miserable.  His palms and soles are macerated from all the hot water.  He gets an IV sited and a quick blood gas is drawn….

So here are the questions:

(1) What is the diagnosis?

(2) Which meds will you try to truncate the vomiting?

(3)  What fluid will you choose to correct his metabolic derangement ??

dav
thanks to @davebergie for the gas image

Casey

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