Hyperemesis Hazel — Hyperemesis Gravidarum: Vomiting, Ketones & Dehydration
This is not morning sickness — she has lost 12 pounds and her urine is full of ketones
At 10 weeks, Hazel cannot keep down water. She has lost 12 pounds, her mouth is dry, and the dipstick shows large ketones.
Hazel has hyperemesis gravidarum: persistent vomiting in pregnancy severe enough to cause weight loss of more than 5% of prepregnancy weight, dehydration, ketonuria and electrolyte imbalance. Repeated vomiting loses hydrogen and chloride, producing hypokalemia and metabolic alkalosis. Care is IV fluid replacement, antiemetics, electrolyte correction, NPO status until vomiting settles, then small dry carbohydrate foods with fluids taken between meals rather than with them.
Read Hyperemesis Hazel's full story →The story arc
The setup
Hazel expects nausea in the first trimester, but by 10 weeks she is vomiting after everything, even sips of water.
The turn
She is dizzy standing up, her mucous membranes are dry, her urine is dark and scant, and she has lost 12 pounds.
The crisis
Labs show low potassium and a rising pH from lost stomach acid.
The save
Hazel receives IV fluids with electrolytes and an antiemetic, stays NPO briefly, then advances to small dry carbohydrate snacks with fluids between meals.
NCLEX study section — Hyperemesis Gravidarum: Vomiting, Ketones & Dehydration
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Maternal & Newborn
Take this chapter into practice questions on the same topic.