Case 20 – An Upset Stomach

Case #20: An Upset Stomach
Author: Michael Gottlieb, MD
Peer Reviewer: Patrick Lank, MD

A 22 year old G1P0 at 30 weeks gestational age presents with mild, diffuse abdominal pain and intermittent non-bilious, non-bloody vomiting over the past few hours. Her review of systems is otherwise unremarkable. She has no past medical history and only takes prenatal vitamins. On further prompting, she endorses taking “half of the bottle” after a fight with her boyfriend four hours prior to arrival.

Vitals: Temp: 98.6, HR: 76, RR: 10, BP: 118/76, O2 Sat: 97% on RA

What is the most likely etiology of this patient’s presentation?
What other clinical symptoms might you expect to see with this patient?
What is the initial treatment for this patient?
What further work-up is required?
What is the disposition for these patients?

References:

Madiwale T, Liebelt E. Iron: not a benign therapeutic drug. Curr Opin Pediatr 18: 174, 2006.

Singhi SC et al. Acute iron poisoning: clinical picture, intensive care needs and outcome. Indian Pediatr 40: 1177, 2003.

Chyka PA, Butler AY. Assessment of acute iron poisoning by laboratory and clinical observations. Am J Emerg Med 11: 99, 1993.

Baranwal AK, Singhi SC. Acute iron poisoning: management guidelines. Indian Pediatr 40: 534, 2003.

Manoguerra AS, Erdman AR, Booze LL, et al: Iron ingestion: an evidence-based consensus guideline for out-of-hospital management. Clin Toxicol (Phila) 43: 553, 2005.

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