Abstract

Here we present the case of a 20-year-old male with a known history of an artificial mechanical aortic valve replacement at ages four and twelve, on chronic warfarin therapy, who presented to our community emergency department for the evaluation of vomiting, diarrhea, generalized malaise and abdominal pain. He was seen at a local urgent care for similar symptoms earlier in the day, subsequently discharged with a diagnosis of mild gastroenteritis; however, according to the patient's sister, upon his return home he looked very unwell and she called an ambulance immediately. He stated the vomiting was nonbloody, nonbilious and without a coffee-ground appearance; the diarrhea likewise was nonbloody, nonmelenic, but mucousy. He had chills, but denies recent fevers, urinary complaints, back pain, chest pain, cough, or dyspnea. No recent illnesses, sick contacts, or travel. The patient denied any other medical or surgical history. Importantly, the patient reported no recent adjustments in his warfarin dose, admitted compliance, with last INR 2.1 two days prior to presentation.

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