A 35-year-old pregnant woman at 8 weeks gestation comes to the emergency department due to persistent nausea and vomiting. The patient has had intermittent nausea for the past week and vomiting for the past 3 days. Now, she is unable to tolerate solids or liquids. Temperature is 36.7 C (98 F), blood pressure is 90/64 mm Hg, pulse is 108/min, and respirations are 14/min. Mucous membranes are dry and capillary refill time is delayed. Cardiac examination shows sinus tachycardia and no murmurs. The abdomen is nontender and nondistended. Compared to her baseline, which of the following sets of serum electrolyte concentration abnormalities are most likely present in this patient?

Question

A 35-year-old pregnant woman at 8 weeks gestation comes to the emergency department due to persistent nausea and vomiting.  The patient has had intermittent nausea for the past week and vomiting for the past 3 days.  Now, she is unable to tolerate solids or liquids.  Temperature is 36.7 C (98 F), blood pressure is 90/64 mm Hg, pulse is 108/min, and respirations are 14/min.  Mucous membranes are dry and capillary refill time is delayed.  Cardiac examination shows sinus tachycardia and no murmurs.  The abdomen is nontender and nondistended.  Compared to her baseline, which of the following sets of serum electrolyte concentration abnormalities are most likely present in this patient?

Quizplus · Accepted Answer

Eductional Objective: Severe vomiting characteristically causes hypokalemic, hypochloremic metabolic alkalosis. The metabolic alkalosis is initiated by loss of gastric H+ from the body, worsened by hypovolemia-induced activation of the renin-angiotensin-aldosterone system, and perpetuated by profound gastric and renal losses of Cl- that lead to hypochloremia and impaired renal HCO₃- excretion. Hypokalemia primarily results from aldosterone-mediated renal K+ losses.

A 35-Year-Old Pregnant Woman at 8 Weeks Gestation Comes to the Emergency