August 2018 Critical Care Case of the Month

Thursday, August 2, 2018 at 8:00AM
Rick Robbins, M.D. in diagnosis, gestational transient thyrotoxicosis, hCG, human chorionic gonadotropin, hyperemesis gravidarum, pregnancy, propylthiouracil, thyrotoxicosis, treatment, vomiting

Emma Simpson, MD

Banner University Medical Center Phoenix

Phoenix, AZ USA

History of Present Illness

A 19-year-old gravida 1, para 0 woman in her early second trimester presented to the Emergency Department with intractable vomiting, green sputum icteric sclerae, chest pain, palpitations and weakness for one week prior to presentation. She was visiting the US from an island in Micronesia. The patient has been experiencing feelings of general malaise since the beginning of her pregnancy: she experienced severe nausea and vomiting throughout her first trimester, and a 4.5 kg weight loss in the 2 months prior to presentation.

PMH, SH, FH

Before becoming pregnant, the patient was active and healthy. She does not smoke and her family history is unremarkable.

Physical Examination

Physical exam showed a thin, small young woman. Her physical examination showed a tachycardia of 114 and icteric sclera but was otherwise unremarkable.

Which of the following should be done? (Click on the correct answer to proceed to the second of six pages)

1. Admit to the hospital with measurement of electrolytes, transaminases and bilirubin
2. Discharge to home with a prescription for pyridoxine/doxylamine
3. Ultrasound
4. 1 and 3
5. All of the above

Cite as: Simpson E. August 2018 critical care case of the month. Southwest J Pulm Crit Care. 2018;17(2):53-8. doi: https://doi.org/10.13175/swjpcc092-18 PDF 

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).