ASN's Mission

To create a world without kidney diseases, the ASN Alliance for Kidney Health elevates care by educating and informing, driving breakthroughs and innovation, and advocating for policies that create transformative changes in kidney medicine throughout the world.

learn more

Contact ASN

1401 H St, NW, Ste 900, Washington, DC 20005

email@asn-online.org

202-640-4660

The Latest on Twitter

Kidney Week

Abstract: FR-PO303

Acid-Base and Electrolyte Disturbances in Severe Hyperemesis Gravidarum

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • 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
Background

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.

Methods

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.

Results

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)].

Conclusion

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.