Hyperemesis Gravidarum

Nauseated

Step 1: View clinicals

A 27 year old primipara presents at 12 weeks of gestation with recurrent, severe nausea and vomiting. She is also lethargic and weak. She was diagnosed with hyperemesis gravidarum two weeks ago, which was managed with IV fluids and anti-emetics. No underlying medical disorders were detected. An ultrasound scan at that time showed a single live intrauterine gestation of 10 weeks. A full blood count is found to be normal.


Step 2: Order all relevant investigations

Liver Profile

AST: 152 U/L (8 - 48) ALT: 158 U/L (7 - 55) Total bilirubin: 0.92 mg/dL (0.1 - 1.0) ALP: 91 U/L (45 - 115) Albumin: 4.2 g/dL (3.5 - 5.0) INR: 1.1 (0.8 - 1.2)

Urine for Ketones

The test is positive for ketone bodies.

Metabolic Panel

K+: 4.7 mEq/L (3.5 - 5) Na+: 142 mEq/L (135 - 145) Blood Urea: 6 mg/dL (7 - 20) Creatinine: 0.7 mg/dL (0.5 - 1.0) Glucose: normal

MRI Brain

The T2 weighted scan shows enhancement of the medial thalamus and inferior colliculus.


Step 3: Select appropriate management

IV Thiamine
IV Glucose
IV Fluids
Antiemetics


Score: ★★☆