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any new palpitations should be assessed promptly by a clinician [5] [9] Severe or persistent upper abdominal pain, particularly if it radiates to the back and is accompanied by vomiting this may indicate pancreatitis or a gallbladder problem and requires prompt medical review Severe or worsening nausea, vomiting, or diarrhoea that is preventing adequate nutrition or hydration, as this may lead to dehydration and, in some cases, acute kidney injury