A 23-year-old man comes to the Emergency Department with severe vomiting, which began
some 90 minutes after eating rice-based takeaway food that he had the night before. He
complains of abdominal cramps, retrosternal pain, and has vomited ten times. He has
struggled to keep water down. There is no diarrhoea. His blood pressure (BP) is 100/70
mmHg; his pulse is 98 beats per minute (bpm) and regular. There is a postural drop of 15
mmHg on standing. He is tender in the epigastrium.
What is the most likely diagnosis?

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