Emergency Department Minute Quiz: Vomiting

Case: A woman in her 50s with a history of hypertension and fibromyalgia presents to the emergency department for gradually worsening vomiting, generalized weakness and body aches over the past 24 hours. She denies syncope, palpitations, chest pain, dyspnea, fever, abdominal pain, diarrhea or other complaints.

Exam: Vital signs are normal except for a pulse of 115. Exam is otherwise normal with no abdominal tenderness

Initial differential diagnosis: Tachydysrhythmia, Electrolyte abnormality, ischemia, dehydration