Nausea and vomiting during pregnancy leading to nystagmus, ataxia, and maternal brain injury

Published:April 05, 2022DOI:
      A 30-year-old primigravida with a single intrauterine pregnancy at 16+1 weeks’ gestation based on last menstrual period (and consistent with an 11-week ultrasound) presented to the emergency department (ED) with protracted nausea and vomiting. Although the patient had not received prenatal care, she had been evaluated in the ED for nausea and vomiting at 11 and 14 weeks’ gestation. She was discharged home from the most recent ED visit after tolerating oral intake and receiving a combination of intravenous (IV) antiemetics and oral potassium repletion. During the current visit, the patient was found to have had a cumulative 60-lb weight loss (13.8% of prepregnancy weight), hypokalemia (2.0 mmol/L), hypomagnesemia (0.1 mmol/L), hypocalcemia (0.3 mmol/L), and elevated liver enzymes (aspartate transaminase [AST], 109 IU/L; alanine transaminase [ALT], 392 IU/L). She was admitted to the hospital for electrolyte repletion and IV fluids but was transferred to the labor and delivery unit after a second-trimester fetal demise was diagnosed and confirmed by ultrasonography.
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        • Oudman E.
        • Wijnia J.W.
        • Oey M.
        • van Dam M.
        • Painter R.C.
        • Postma A.
        Wernicke’s encephalopathy in hyperemesis gravidarum: a systematic review.
        Eur J Obstet Gynecol Reprod Biol. 2019; 236: 84-93
        • Dasari P.
        • Priyadarshini S.
        Neglected woman with hyperemesis gravidarum leading to Wernicke encephalopathy.
        BMJ Case Rep. 2020; 13e238545
        • Anwar J.
        • Soomro S.
        • Javed K.
        • Omer S.
        MRI findings in acute Wernicke’s encephalopathy, caused by hyperemesis gravidarum.
        J Ayub Med Coll Abbottabad. 2016; 28: 409-410
        • Popa S.L.
        • Barsan M.
        • Caziuc A.
        • et al.
        Life-threatening complications of hyperemesis gravidarum.
        Exp Ther Med. 2021; 21: 642
        • Zara G.
        • Codemo V.
        • Palmieri A.
        • et al.
        Neurological complications in hyperemesis gravidarum.
        Neurol Sci. 2012; 33: 133-135