This case involves a 21-year-old pregnant female, , G1P0, who presents to the emergency room with symptoms consistent with **hyperemesis gravidarum* at 6 weeks and 2 days gestation, with an estimated delivery date of May 10, 2025. The patient reports being unable to keep down any food or liquids, leading to persistent nausea, vomiting, and severe fatigue. She describes immediate nausea and emesis after any oral intake, whether food or fluid. Despite attempts at self-hydration, her condition has worsened, prompting her presentation to the ER.
During her evaluation, an ultrasound confirmed an intrauterine pregnancy consistent with her gestational age. Additionally, concerns were raised about a *potential urinary tract infection* (UTI) due to symptoms and laboratory findings, for which she was empirically started on *Rocephin* (ceftriaxone) while awaiting culture results. She is also constipated, reporting that she has not had a bowel movement for the past two days, likely due to decreased oral intake.
Gravida: 1
Раra:0
Term:0
Preterm:0
AB:0
Living:0
### Vitals:
– *Pulse*: 63 beats per minute (bpm)
– *Respiratory Rate*: 17 breaths per minute
– *Blood Pressure*: 105/55 mmHg
– *Temperature*: 97.4°F (36.3°C)
### Presenting Symptoms:
– *Persistent nausea and vomiting*: The patient reports that she vomits immediately after attempting to eat or drink.
– *Fatigue*: Likely secondary to dehydration and malnutrition from the inability to retain oral intake.
– *Constipation*: No bowel movement for the past two days.
### Labs:
– *Hemoglobin*: 10.8 g/dL (low, indicating mild anemia).
– *White Blood Cell Count (WBC)*: 12.3 x 10³/µL (elevated, possibly reflecting infection).
– *Potassium*: 3.2 mmol/L (low, reflecting hypokalemia due to vomiting).
– *Bicarbonate (CO2)*: 16 mmol/L (low, indicating metabolic acidosis, likely from prolonged vomiting and dehydration).
– *Creatinine*: 0.5 mg/dL (normal, indicating preserved kidney function despite dehydration).
– *Anion Gap*: 17 (elevated, suggesting an anion gap metabolic acidosis).
### Medications Administered:
1. *Ceftriaxone (Rocephin)* 1,000 mg IV: Given empirically for a suspected urinary tract infection (UTI) pending culture results.
2. *Diphenhydramine (Benadryl)* 12.5 mg injection: Administered for symptomatic relief of nausea.
3. *Famotidine (Pepcid)* 20 mg IV: To reduce gastric acid production and provide gastrointestinal relief.
4. *Promethazine (Phenergan)* 12.5 mg rectal suppository: Prescribed for nausea and vomiting that has been resistant to oral medications.
### Assessment:
This patient is presenting with classic *hyperemesis gravidarum*, a severe form of nausea and vomiting during pregnancy. She is unable to maintain adequate oral intake, leading to dehydration, electrolyte imbalances (hypokalemia), mild anemia, and metabolic acidosis. The suspected urinary tract infection, indicated by the elevated white blood cell count and clinical signs, is being treated with antibiotics while awaiting definitive culture results.
### Physical Examination:
– The patient appears fatigued but is *alert* and *oriented* to person, place, and time.
– *No signs of acute distress*, and her physical examination reveals no concerning findings. Her abdomen is soft and non-tender, and her uterus is appropriately enlarged for her gestational age.
– *No respiratory or cardiovascular abnormalities* were noted.
### Treatment Plan:
1. *NPO* (nothing by mouth) status due to the patient’s inability to retain any oral intake. Hydration will be maintained through *0.9% normal saline IV at 125 cc/h* to address dehydration and electrolyte imbalances.
2. *Antiemetics*:
– *Ondansetron (Zofran)* 4 mg IV PRN to control nausea and vomiting.
– *Promethazine (Phenergan)* 12.5 mg rectal suppository to be given for nausea if Zofran is insufficient.
3. *UTI Management: Continue **Rocephin* for suspected urinary tract infection pending urine culture results.
4. *Electrolyte and Constipation Management: Due to the patient’s inability to take anything orally, a **Fleet enema* has been recommended to relieve constipation.
5. *Prenatal vitamins* will be administered intravenously due to her inability to retain oral supplements.
6. *Daily lab monitoring*: Regular monitoring of electrolytes, renal function, and infection markers to assess the progression of her condition.
7. *Follow-Up Care*: Arrangements are being made for the patient to establish and maintain ongoing obstetrical care after discharge for continued management of her pregnancy and any further complications from hyperemesis.
### Conclusion:
The patient is being admitted for inpatient management of *hyperemesis gravidarum*, dehydration, and suspected UTI. The treatment plan focuses on rehydration, electrolyte correction, infection management, and symptom control. Close monitoring of her lab results and clinical status will be essential to ensure improvement. The patient will require continued follow-up with her OB for prenatal care to monitor her pregnancy progression and manage any ongoing symptoms.