Case 27-2008: A 64-Year-Old Man with Abdominal Pain, Nausea, and an Elevated Level of Serum Creatinine

A 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. He had a history of recurrent epigastric pain, which had been attributed to pancreatitis and gastroesophageal reflux disease. One week before admission, epigastric pain recurred, with nausea and vomiting; 3 days before admission, he stopped all oral intake, but symptoms worsened. On admission, the serum creatinine level was 3.5 mg per deciliter, and the urea nitrogen level was 28 mg per deciliter. Intravenous fluids were administered, without improvement. A diagnostic procedure was performed. A 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated serum creatinine level. He had a history of recurrent epigastric pain. On admission, the serum creatinine level was 3.5 mg per deciliter. Presentation of Case A 64-year-old man was admitted to the hospital because of abdominal pain, nausea, and an elevated level of serum creatinine. The patient had been in his usual state of health until 4 months before admission, when he was admitted to this hospital for 10 days because of abdominal pain. Acute pancreatitis and gastritis due to Helicobacter pylori were diagnosed. His symptoms diminished minimally after treatment with amoxicillin, metronidazole, and a proton-pump inhibitor and a shift to a bland diet. During the next 2 months, he was evaluated repeatedly by gastroenterologists, visited the emergency department multiple times because . . .