A 26 year old woman is brought to the emergency room due to 2-hour history of hematemesis. She was invited to a banquet at her work and she vomited twice with a considerable amount of blood. Her medical, surgical and family histories are unremarkable. She visits her dentist regularly for recurrent dental caries. She doesn’t smoke or drink alcohol. Her pulse is 100/min, blood pressure is 104/66 and her temperature is 97.8 F. Abdomen is soft, non-tender with no organomegaly. Her laboratory tests are as follows: Serum sodium 136 meq/L. Serum potassium 2.6 meq/L. Serum chloride 84 meq/L. Serum bicarbonate 38 meq/L. Endoscopic examination reveals erosive esophagitis without any scars or adhesions. What is the most likely diagnosis?
A-Bulimia nervosa
B-CREST syndrome
C-Mallory-Weiss syndrome
D-NSAID-induced esophagitis
E-Staphylococcal food poisoning
Answer
This is a typical presentation of bulimia nervosa suggested by history of recurrent dental caries and laboratory investigations. Bulimia is characterized by low chloride, low potassium and high bicarbonate. Mallory-Weiss is mainly related to alcohol binge. This patient does not drink alcohol.
The correct answer is A
Alhamdlh been there! May help us through. amin