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Image challenge
A woman with recurrent vomiting and body cramps
  1. Halil Yildiz1,
  2. Florence Dupriez2
  1. 1 Department of Internal Medicine, Saint Luc University Hospital, Brussels, Belgium
  2. 2 Department of Emergency Medicine, Saint Luc University Hospital, Brussels, Belgium
  1. Correspondence to Dr H Yildiz, Service de médecine interne générale, Cliniques universitaires St-Luc, Avenue Hippocrate 10, Brussels B-1200, Belgium; h_tur.bel{at} or halil.yildiz{at}

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Clinical introduction

A 68-year-old woman with pancreatic cancer undergoing chemotherapy presented to the emergency department with a week of vomiting and body cramps. Vital signs were: BP 130/70 mm Hg; HR 80 bpm; RR 14 bpm and oxygen saturation 100% while breathing ambient air. Laboratory investigations showed normal calcium, magnesium and albumin levels; hypokalaemia level at 2.3 mmol/L (normal range 3.5–5.0 mmol/L) and bicarbonate level at 42 mmol/L (normal range 22–29 mmol/L).

While the nurse was taking …

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  • Contributors HY and FD contributed equally to the diagnosis, management of patient and to the writing of this ‘image challenge’.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.