Emergency Files

Case description A 29-year-old previously healthy man presents to the emergency department (ED) for having more than 10 episodes of vomiting during the past 8 hours. He denies any headache, recent head injury, fever, chest pain, or abdominal pain. His bowel movements are normal. He has no sick contacts and has not recently traveled. He has had no intra-abdominal surgeries. He takes no medications. His social history is remarkable for prison tattoos, regular cocaine use (2 weeks since last use), and regular marijuana use (smoking 1 to 3 joints per day). He denies intravenous drug use and admits to occasional alcohol consumption (3 days since last use). On examination, he is nauseated and retching