Some cases you never forget, one of them would be relevant to recall here. A young skinny man who had just crossed over to the joys of adulthood at 18 years of age, had been helping his older uncle with yardwork chores for a few days with barely a morning snack and only water most of the day (If I could be young again and have all that energy again ! ). Exhausted,he skipped dinner and slept off only to wake up in the morning with a bothersome epigastric pain and feeling a little short-winded. Anxious, his uncle brought him to ER, labs showed mild anion gap acidosis with low bicarb levels and elevated ketones – starvation ketosis!
Epigastric pain conjures up an image of a puking patient clutching their epigastric area – so I made a mnemonic out of ‘PUKING’ to help me recall causes quickly …coz… you know… differential diagnosis is king 😎 ! Here goes:
P – Pancreatitis
U – Ulcers (Gastric / Duodenal)
K – Ketosis (Alcohol, Diabetic, Starvation)
I – Indigestion, Intolerance (Lactose), Intestinal Obstruction/Ileus, Ischemic (GI or Cardiac)
N – Nerve pain: Nerve-entrapment (ACNES) or Neuralgia from Shingles (pain can happen before rash)
G – Gastritis (Viral, Alcohol, Meds), Gallstones/biliary, GERD
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