A 23-year-old primigravida presents at 6 weeks gestation with persistent nausea and vomiting, inability to keep down oral fluids, and a 6% loss of pre-pregnancy body weight. Urinalysis demonstrates 3+ ketones and high specific gravity. Electrolytes reveal hypokalemic, hypochloremic metabolic alkalosis. What is the diagnosis?
Answer and explanation
Correct answer: B. Hyperemesis gravidarum
- Step 1: Hyperemesis gravidarum is a severe form of nausea and vomiting of pregnancy characterized by intractable vomiting, dehydration, ketonuria, electrolyte derangements, and weight loss (> 5%).
- Step 2: Management requires hospitalization, intravenous crystalloid rehydration with thiamine supplementation, and antiemetic therapy.
Answer
Hyperemesis gravidarum.
Why not the others: 'Normal physiological morning sickness' is mild, self-limited, and does not produce significant dehydration, ketonuria, or electrolyte depletion; 'Acute viral gastroenteritis' is characterized by prominent watery diarrhea and fever; 'Acute fatty liver of pregnancy' occurs in the third trimester presenting with acute liver failure.
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