Nauseated

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.

Select Relevant Investigations
Liver Profile

Performed

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

Performed

The test is positive for ketone bodies.
Metabolic Panel

Performed

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

Performed

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

Select Relevant Management
IV Thiamine
IV Glucose
IV Fluids
Antiemetics