Mr. Collins is a 59-year-old male with a history of vomiting…
Mr. Collins is a 59-year-old male with a history of vomiting blood. He has been in good health except for hypertension and “stomach problems”, including chronic indigestion and heartburn usually relieved with over-the-counter antacids. He reports a poor appetite and recent weight loss. Mr. Collins states that he has a very stressful job at times, and he jokes “I knew this job would give me an ulcer”. Mr. Collins reports that last evening the heartburn was particularly bad, but he experienced relief after taking his antacids. He awakened early today with nausea, bloody emesis, weakness, and dizziness. He also reports black tarry stools. His wife drove him to the emergency room where he was admitted with an upper gastro-intestinal bleed. He is alert and oriented X3, breathing is quiet and unlabored. Skin and mucous membranes are pale and dry. There is 90 mL of dark, concentrated urine in a bedside urinal. An endoscopy reveals esophageal metaplasia and numerous gastric and duodenal ulcers. A chest x-ray shows normal lung fields with myocardial hypertrophy. An electrocardiogram (ECG) shows sinus tachycardia with occasional Premature Ventricular Contractions (PVCs). Vital signs are: 36.9 C, 112, 30, 94/42, and 98% Oxygen saturation. The following laboratory values were assessed: Serum Electrolytes Na 130 mEq/L Cl 89 mEq/L K 6.2 mEq/L BUN 52 mg/dl Creatinine 2.4 mg/dl CO2 16 mmol/L Ca 7.6 mg/dL Mag 1.5 mEq/L Phosphorous 4.4 mg/dL Glucose 138 mg/dL Albumin 3.0 g/dL Lactic Acid 1.8 mEq/L Mr. Collins’ heartburn and gastric and duodenal ulcers may have been caused by increased gastric acid secretion secondary to secretion of which of the following?