A 40-year-old woman at 10 weeks gestation presents with severe nausea, vomiting, and weight loss. Blood tests show: Urine ketones: Positive Serum sodium: 130 mmol/L (low) Serum potassium: 3.0 mmol/L (low) What is the most appropriate next step? A) Oral antiemetics B) IV fluids and thiamine C) Metoclopramide injection D) Proton pump inhibitors E) Small frequent meals Correct Answer: B) IV fluids and thiamine Explanation: Hyperemesis gravidarum: Severe nausea/vomiting + weight loss + dehydration First-line treatment: IV fluids (0.9% saline with K⁺ if needed) Thiamine (to prevent Wernicke’s encephalopathy) Antiemetics (metoclopramide, ondansetron, cyclizine) A) Oral antiemetics → Incorrect. Not effective in severe dehydration. C) Metoclopramide injection → Incorrect. Helps, but IV fluids first. D) Proton pump inhibitors → Incorrect. No role in hyperemesis gravidarum. E) Small frequent meals → Incorrect. Helps mild cases, not severe dehydration. Key Tips for PLAB 1: ✅ Hyperemesis gravidarum = Severe vomiting, weight loss, ketonuria ✅ Treat with IV fluids + thiamine ✅ Prevent Wernicke’s encephalopathy (thiamine before glucose!)
