4. 1 and 3

The patient has hyperemesis gravidarum. Although 50% of women have vomiting during the first trimester of pregnancy and additional 25% have nausea, hyperemesis gravidarum has been defined as more than three episodes of vomiting per day such that weight loss of 5% or three kilograms has occurred and ketones are present in the urine (1). Many consider this a medical emergency and the patient should be admitted to the hospital for observation and treatment.

Our patient was mildly hypokalemic and hyponatremic with mildly elevated transaminases and bilirubin.

Which of the following are possible causes of hyperemesis gravidarum? (Click on the correct answer to be directed to the third of six pages)

  1. Choriocarcinoma
  2. Hepatitis
  3. Urinary tract infection
  4. 1 and 3
  5. All of the above

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