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.