Case presentation A 70-year-old male presented to the ED with complaints of multiple episodes of hematemesis over the past 24 hours. In addition, he reported headache , epigastric pain , malaise , and increasing heartburn for six days.
The patient had been taking 15 to 25 calcium-containing antacid pills to get relief from the heartburn. Medical history Gastroesophageal reflux disease (GERD) Hypothyroidism post-radioactive iodine treatment Ischemic heart disease Physical and clinical examination Mildly confused Dry oral mucosa Metabolic alkalosis Vital signs: Normal Bone survey: No evidence of multiple myeloma Ultrasound of kidneys: Normal Laboratory findings Urea: 14.4 mmol/L Serum creatinine: 398 µmol/L Serum bicarbonate: 32 mmol/L Serum calcium: 4.38 mmol/L Parathyroid hormone (PTH): Low Thyroid test: Normal Serum protein electrophoresis (SPEP): Normal Further tests An upper…
