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Nausea, Vomiting, and Epigastric Pain in an Elderly Diabetic
Mario Medero, MD;
David Hoffman, MD;
William Lineaweaver, MD;
Charles King, MD;
Thomas O. Rumley, MD
JAMA. 1985;254(11):1485-1486.
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A 61-year-old man presented with the complaints of nausea, vomiting, and severe epigastric pain. An anteroposterior roentgenogram of the abdomen demonstrated a conclusive diagnostic finding.
History
The patient was a noncompliant, poorly regulated diabetic receiving 54 units of isophane insulin (NPH [neutral protamine hagedorn] insulin) and 20 units of insulin by subcutaneous injection daily. His medical history was significant for multiple sequelae of diabetes. On physical examination, he was febrile (temperature, 38.5 °C), alert, and in no apparent distress. His abdomen was moderately distended, tender, and had normal bowel sounds. Laboratory findings included an elevated serum glucose level of 345 mg/ dL, urine glucose concentration of 3%, and white blood cell count of 19,000/cu mm. Roentgenograms of the chest and abdomen demonstrated radiological findings that will be described subsequently (Fig 1). (To the reader: Observe the area of the stomach with extra care.)
Diagnosis
Gastric emphysema associated with gastroparesis in
. . . [Full Text PDF of this Article]
Author Affiliations
From the Departments of Surgery (Drs Medero, Hoffman, Lineaweaver, and Rumley) and Gastroenterology (Dr King), University of Florida College of Medicine and the Veterans Administration Medical Center, Gainesville.
Footnotes
Reprints not available.
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