Hyperemesis gravidarum — CCFP MCQ

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HardWomen's health/OB/GYNHyperemesis gravidarumCCFP

A 32-year-old G1P0 at 9 weeks' gestation has vomiting 8 times daily, weight loss of 4 kg and ketonuria on urine dip. Blood pressure is 94/60 mmHg, pulse 108/min, and serum potassium is 3.0 mmol/L. There is no abdominal pain or vaginal bleeding. What is the most appropriate next step in management?

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Correct answer: A — Arrange urgent IV fluids, electrolyte correction and antiemetic therapy

This patient meets criteria for hospitalization and acute intervention in hyperemesis gravidarum: persistent, frequent vomiting (8×/day), significant weight loss (4 kg), objective dehydration (ketonuria, symptomatic hypotension 94/60, tachycardia 108), and life-threatening hypokalemia (K⁺ 3.0 mmol/L). Canadian guidelines (CMAJ, 2024) and consensus recommend immediate IV rehydration with electrolyte repletion (including thiamine 100 mg) and IV antiemetics for patients unable to tolerate oral intake. A: Reassurance delays necessary acute care and ignores objective signs of dehydration and electrolyte emergency. C: Oral iron worsens nausea and does not address hypokalemia, dehydration, or the metabolic crisis. D: Stopping prenatal vitamins is not a treatment for hyperemesis and addresses neither the acute condition nor the mechanism. E: CT imaging is unnecessary given clear clinical diagnosis (ketonuria, orthostatic hypotension, ketonemia) and delays definitive management; imaging carries unjustified radiation risk in early pregnancy.

Reference: CMAJ. 2024 Apr 14. 'Diagnosis and treatment of hyperemesis gravidarum.' https://www.cmaj.ca/content/196/14/E477