CASE 002 · Emergency Department · Intermediate · 8–12 min
The Patient Who Won't Stop Vomiting
· Patient arriving
24-year-old male — “I can't stop throwing up.”
Walks in at 11:20 PM, brought by his roommate. Ten episodes of vomiting since last night.
BP 98/60HR 124RR 30 deepSpO₂ 99% RATemp 99.1°F
You do not get the diagnosis. You get the patient. Reason your way there.
What SHOULD be happening?A — Assess Normal
Insulin lets glucose enter cells for energyCells fed — lipolysis suppressedBlood glucose held in a narrow rangeNo ketone production beyond traceBlood pH locked between 7.35–7.45
Somewhere, the key that lets sugar into cells has gone missing — and the body has started burning something else.
RUN IT · ACTIVEThis patient deteriorates while you work. Time matters.
Maldek cases are for healthcare education and clinical-reasoning training. They do not replace local protocols, faculty instruction, clinical supervision, or professional judgment.