Most patients experience nausea and vomiting, at times to the point of dry heaves. The patient appears acutely ill and is sweating. Respirations are shallow and rapid. BP may be transiently high or low, with significant postural hypotension. Sensorium may be blunted to the point of semicoma.
Scleral icterus is occasionally present.
Examination of the lungs may reveal limited diaphragmatic excursion and evidence of atelectasis. Abdominal tenderness always occurs and is often severe in the upper abdomen and less severe in the lower abdomen. The entire abdomen rarely exhibits severe peritoneal irritation in the form of a rigid boardlike abdomen. Bowel sounds may be hypoactive. Rectal examination usually discloses no tenderness, and the stool usually tests negative for occult blood.