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Author: Órlaith Geary / Editor: Nick Tilbury / Codes: GP9, NepC4, NepP1, NeuC16, ObC14, ObC8, ObP3, SLO1, VC3 / Published: 29/11/2024

A 19-year-old woman presents to the Emergency Department (ED) with a two-week history of intractable nausea and vomiting.

Her last menstrual period was 9 weeks ago. She has attended her General Practitioner (GP) earlier in the week who has confirmed pregnancy on a urine pregnancy test and prescribed anti-emetics for nausea and vomiting of pregnancy (NVP).

She has a past medical history of epilepsy for which she takes levetiracetam twice daily.

The patient states that she is unable to tolerate anything orally, including her anti-emetics and anti-epileptics. She is also concerned as she has lost approximately 3kg of weight over the past week and is passing less urine than usual.

You request some blood tests including a blood gas and also ask the patient for a urine sample.

Venous blood gas:

  • pH 7.48
  • PaCO2 4.9 kPa
  • PaO2 5.8 kPa
  • Na+ 129 mmol/L
  • K+ 2.9 mmol/L
  • Cl- 91 mmol/L
  • Ca2+ 1.2 mmol/L
  • Glucose 4.5 mmol/L
  • Lactate 2.5 mmol/L

Urine Dip:

  • Ketones +++
  • No leucocytes or nitrites.