Hyperemesis gravidarum — MCCQE Part 1 MCQ

Correct answer: B — Admit or use an appropriate monitored pathway for IV isotonic fluid, electrolyte correction, antiemetics, and thiamine before dextrose

She has hyperemesis gravidarum with clinically important dehydration, inability to retain fluid, substantial weight loss, and hypokalaemia despite outpatient treatment. She needs monitored intravenous isotonic rehydration, potassium and other electrolyte correction, and escalation or combination of pregnancy-compatible antiemetics. Thiamine should be given to patients admitted with prolonged vomiting, particularly before dextrose-containing fluid or parenteral nutrition, to reduce Wernicke risk. Dextrose alone can worsen electrolyte problems and should not be used until thiamine has been addressed and sodium is appropriate. Urine ketones do not reliably grade dehydration or determine discharge. Nutrition support is reserved for refractory cases after multidisciplinary review, not as the first escalation. Discharge is appropriate only after clinical and biochemical improvement with a sustainable oral plan, follow-up, and return precautions. Pregnancy termination is not routine treatment for hyperemesis.

Reference: Royal College of Obstetricians and Gynaecologists, Green-top Guideline No. 69 (2024): https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/the-management-of-nausea-and-vomiting-of-pregnancy-and-hyperemesis-gravidarum-green-top-guideline-no-69/