Question of the Week # 200

200)  A 26 year old pregnant woman is evaluated in the emergency Room for severe weakness and dehydration from persistent vomiting. She is a primigravida at 9 weeks gestation. She reports that her nausea and vomiting started at 5 weeks of pregnancy and have progressively become worse. She denies any abdominal pain or vaginal bleeding. She denies any headache. Her bowel movements are normal. Her past medical history is unremarkable. Her pre-pregnancy weight was 60lbs but now she weighs about 55lbs. Physical examination reveals dry oral mucosa. Laboratory tests reveal Serum sodium 140 meq/l, potassium 3.2meq/L, Chloride 102meq/l, Bicarbonate 34meq/L. hematocrit of 52 (normal = 36 to 46%).  Urine reveals ketonuria. The most appropriate next step in investigating this patient:

A)     Hemoglobin A1C level

B)      Serum Uric acid

C)      Urine for total protein

D)     Ultrasound Pelvis

E)      Plain X-Ray abdomen

8 Responses

  1. A

    • However, a prospective follow-up study showed high serum uric acid is associated with higher risk of type 2 diabetes, independent of obesity, dyslipidemia, and hypertension

  2. D) Pelvic ultrasound
    to check twin pregnancy, Hydatidiform mole

  3. Urine ketones is what you want to check mostly in Hyperemesis Gravidarum, as it is not here amongst the options, the other test would be to check for a pelvic ultrasound to rule twin or ectopic pregnancy because the highest association of vomiting in early pregnancy is with the imbalance of hormones mostly Beta HCG.

    Correct Answer D

    • I think you mean 60 kg not 60 Ibs?

  4. D)

  5. D

  6. The answer is D

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