A 35-Year-Old Woman With Shock, Pulseless Electrical Activity Arrest, and Hemodynamic Collapse

A 35-year-old woman presented with 2 days of nausea, abdominal pain, and fatigue. On the day of presentation, her abdominal pain worsened, she developed progressive somnolence, and had several bouts of nonbloody, nonbilious emesis. She denied prior headache, rashes, and toxic or illicit ingestions. The patient had a medical history of diabetes mellitus type 2, hyperlipidemia, and mild cognitive delay (highly functional, maintaining a job, home, and medication responsibilities). She reported taking only simvastatin and short-acting insulin. She had an unknown adverse reaction to metformin. She was a nonsmoker and denied history of drug and alcohol use.