A 29-year-old woman presents at 10 weeks gestation with excessive nausea and intractable vomiting, resulting in a 6% body weight loss, ketonuria, and hypokalemic metabolic alkalosis. Transvaginal ultrasound confirms a single viable intrauterine pregnancy. What is the diagnosis?
Answer and explanation
Correct answer: D. Hyperemesis gravidarum
- Step 1: Severe, persistent nausea and vomiting in early pregnancy accompanied by significant weight loss (>5%), dehydration, ketonuria, and electrolyte disturbances is diagnostic of hyperemesis gravidarum.
- Step 2: Ultrasound demonstrates a normal single intrauterine pregnancy, ruling out twin pregnancy and gestational trophoblastic disease (molar pregnancy).
- Step 3: Acute fatty liver occurs in the third trimester; cholecystitis features right upper quadrant pain and gallstones.
Answer
Hyperemesis gravidarum.
Why not the others: Ultrasound excludes hydatidiform mole; AFLP occurs in late pregnancy; normal gallstones rules out acute cholecystitis.
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