At a Loss

A 31-year-old woman who had been unable to eat or drink for the preceding week was admitted to the hospital. For the preceding 8 months she had had nausea, vomiting, and abdominal discomfort and several episodes of crampy epigastric pain with vomiting and intermittent chills and sweats, but no documented fevers. She also had loose, pale stools occasionally, but these episodes did not represent a notable change
from her baseline. Gradually increasing fatigue, loss of appetite, and a recent weight loss of several kilograms were also reported. The patient’s medical history included hypertension, obesity, and migraine headaches. She had undergone Roux-en-Y gastric bypass 5 years before presentation and subsequently lost approximately 45 kg (100 lb). Her weight had been stable for the past few years; her body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) was 33. She had undergone laparoscopic cholecystectomy 10 years before presentation. Her only medication was nifedipine, and she
took a multivitamin on occasion. Mehr