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This case is an account of the events that led Drs. Robin Warren and Barry Marshall to the bacterial theory of ulcers. The two physicians refused to accept the standard explanations for what they had observed and instead developed an alternative hypothesis, saving countless patients from unnecessary pain and suffering. Along the way they transformed the way the medical community viewed peptic ulcer disease. The case shows the importance of curiosity, serendipity, and tenacity in scientific inquiry; how science is built upon the work of others; how assumptions can cloud people's views, leaving them closed to new ideas; and how scientific "truth" can and does change when faced with new data and new interpretations. It is appropriate for use in any course at the high school or undergraduate level that teaches students about the scientific method and/or the sociology, nature, and history of science.

An elderly woman living independently with some help from her family is brought to the local emergency room because she is confused and vomiting. While her son suspects a stroke, a quick battery of laboratory tests indicates that her current problems are the result of impaired kidney function, an old-fashioned home remedy for ulcers, and her prescribed blood pressure medication. The combination of patient- and drug-related factors produces an acid-base disorder responsible for her confusion. This disorder further disrupts her kidney function. The case illustrates secretion and reabsorption processes in the kidney tubule which regulate plasma and urinary electrolytes (including calcium) and pH. The role of bicarbonate in maintaining systemic pH is emphasized. Interactions among the renal, respiratory and nervous systems in the regulation of systemic pH are also illustrated. Further, basic principles of pharmacotherapy and issues related to the appropriate use of medications are introduced. The case was developed for use in a physiology or human anatomy and physiology course, but it might be used in undergraduate nursing courses as well (e.g., pharmacology, pathophysiology).