امرأة عمرها ٢٤ سنة حامل في الأسبوع ٩، تتقيأ أكثر من ١٠ مرات يومياً منذ أسبوعين، ونقص وزنها ٤ كغ، ولا تستطيع شرب الماء. النبض ١١٨، والضغط ١٠٠/٦٢، والكيتونات في البول عالية، والبوتاسيوم ٣٫٠. ما الأرجح وما العلاج؟

A 24-year-old at 9 weeks’ gestation has vomited over 10 times daily for two weeks, lost 4 kg and cannot keep water down. HR 118, BP 100/62, heavy ketonuria, potassium 3.0. What is likely and how is it treated?

1. Pregnancy anxiety needing reassurance only
2. Hyperemesis gravidarum, needing IV fluids, electrolytes, antiemetic and thiamine
3. Normal morning sickness managed with dry crackers in the morning
4. Viral gastritis managed with plenty of juice by mouth

Answer: B) Hyperemesis gravidarum, needing IV fluids, electrolytes, antiemetic and thiamine. Severe vomiting with >5% weight loss, dehydration, ketosis and electrolyte imbalance is hyperemesis. It needs IV fluids, potassium, a safe antiemetic and thiamine before glucose to prevent Wernicke encephalopathy.