You are answering a USMLE-style medical question. Question: A 25-year-old girl is brought to the emergency room after a suicide attempt. Her mother states that she found a large empty pill bottle next to her. The patient is conscious and tearful. She is currently complaining of severe abdominal pain but refuses to give any other history. She has a blood pressure of 135/86, respiratory rate of 18/min, and heart rate of 86/min. On examination, her abdomen is exquisitely tender with evidence of crepitus in the epigastric region. Abdominal CT reveals a gastric perforation. Which of the following is the most likely cause? Options: A) Decreased production of PGE2 B) Buildup of a toxic metabolite due to kidney disease C) Increased stimulation of the vagus nerve D) Hypovolemia Reply with ONLY the letter of the correct answer (A, B, C, or D). No explanation.