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Abstract: FR-PO303

Acid-Base and Electrolyte Disturbances in Severe Hyperemesis Gravidarum

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical


  • Rivera, Maria Soledad, Ochsner Clinical School, New Orleans, Louisiana, United States
  • Estremadoyro, Luis, Universidad Peruana Cayetano Heredia, Lima, Peru
  • Velez, Juan Carlos Q., Ochsner Clinical School, New Orleans, Louisiana, United States

Hyperemesis gravidarum (HG) is a complication of pregnancy characterized by incessant vomiting and reduced oral intake. However, the effect of severe HG on acid-base and electrolyte balance has not been previously examined.


A cross-sectional study was conducted to assess for acid-base and electrolyte abnormalities in pregnant women with symptoms of HG that were severe enough to lead to a visit to an emergency room.


A total of 22 women [9 (41%) primigravida] were included over a 6-month enrollment period in a large city hospital. Median age was 25 (17 – 38) and median gestational age was 10 (5 -16) weeks. Median duration of HG prior to arrival was 24 (3 – 63) days. Vomiting episodes per day were 6 (3 – 12) and ketonuria was found in 16 of 22 women (73%). Dehydration was clinically evident in 18 of 22 (82%) and the mean change in body weight was –12%. The mean arterial pH was 7.41 (7.30 - 7.50), mean bicarbonate was 19 mEq/L (14 – 28) and mean pCO2 was 29 mmHg (19 - 39). Physiological respiratory alkalosis was found in 17 of 22 (77%), metabolic alkalosis from vomiting was present in 10 of 22 (45%) and high anion-gap metabolic acidosis from starvation ketosis in 12 of 22 (55%) patients. Among them, 8 of 22 (36%) presented with a triple acid-base disorder, i.e. simultaneous respiratory alkalosis, metabolic alkalosis and metabolic acidosis. Only 2 (9%) patients exhibited no acid-base disorder. The presence of high anion gap metabolic acidosis was associated with a greater degree of weight loss (p < 0.05) and a lower age (p < 0.05). In addition, 9 of 22 (41%) patients were hypokalemic [mean K 3.5 mEq/L (2.4 – 4.2)], 7 of 22 (32%) were hyponatremic, and only 1 patient was hypernatremic [mean Na 139 mEq/L (128 – 148)].


Triple acid-base disorder of respiratory alkalosis, metabolic acidosis and metabolic alkalosis is the most common diagnosis in severe HG. Lower age and a greater degree of reduction in body weight are associated with high anion gap metabolic acidosis. Hypokalemia and dysnatremia can also occur. Acid-base/electrolyte assessment in HG is warranted.