CARLOS EDUARDO REIS
A 35-year-old woman was admitted to the hospital after 2 days' proctated vomiting during which time she has been able to ingest nothing. She decided to go to the hospital this morning because of progressive weakness.
Further history revealed that she has a duodenal ulcer and was in treatment with cimetidine. The patient's past medical history is significant because of pirosis and several episodes of vomiting sometimes with blood.
Physical examination revealed a well-developed, white womam who is slightly anxious but in no acute distress, with signs of dehydration. Her skin were pale and vital signs were BP 90/70; pulse 112/min. and regular; temp. 100 degrees F, respirations of 16/min . Pupils were equal in size, round and reactive to light. Her extremities showed no cyanosis or edema; she has prolonged capillary refill
Her lungs are clear upon auscultation and her heart rhythm is regular, with a normal first and second sound. Abdomen was soft, nontender, without masses or guarding. Neurologic examination revealed a severe proximal muscle weakness. Body weight on admission was 65 Kg, but her normal weight was 70 kg.