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.
Module Content
Bleeding in Pregnancy
This session covers the emergency management of both bleeding in early pregnancy and antepartum haemorrhage (APH) Appropriate investigation and initial emergency interventions are considered including rhesus status and the administration of anti-D immunoglobulin.
Gastroenteritis in Children under 5 years of age
This session describes the natural history and aetiology of paediatric gastroenteritis.
Gynae - Induction
Gynae presentations to the emergency department are fairly common, yet fill everyone with dread. The management is similar to any other medical problem
2 Comments
Great Revision
great learning