Germes-Piña F, Acosta-Orozco D M, Flores-Franco R A, Verdugo-Castro P N
Ginecol Obstet Mex. 2016 Sep;84(9):586-92.
The hyperemesis gravidarum is a severe illness of nauseas and vomit that is present in the first trimester of the pregnancy, it has an incidence of 0.3 to 2%, it has been associated to weight loss, electrolytic disturbances, ketonuria, dehydration and in very seldom cases spontaneous pneumomediastinum.
A 21 years old female patient, primigest, in the first trimester of gestation, she started her disease with nauseas and vomiting more than 15 times during 6 hours period, odynophagia, dysphonia and pain in the cervical region, loss of 5 kilograms in the last month. The physical examination showed the patient in bad conditions, dehydration, neck with volume increased and emphysema subcutaneus, crakles until torax. Laboratory findings with hypokalemia, leukocytosis, acute kidney failure, and elevation of hepatic enzymes. The initial treatment was with intravenous fluids resuscitation, hydroelectrolytic balance restoration, antiemetic treatment and rest, it was taken TC of neck and torax, and was exclude any laryngeal and esophageal injury and perforation, but it showed air in the mediastinum. Conservative management with favorable evolution and completed resolution in 7 days.
It is very important that the medical doctor must keep in mind the different diagnosis of and take an opportune decision in case of present those complications potentially fatal to the mother.
妊娠剧吐是妊娠早期出现的严重恶心和呕吐疾病，发病率为0.3%至2%，与体重减轻、电解质紊乱、酮尿症、脱水有关，在极少数情况下还与自发性纵隔气肿有关。
一名21岁初产妇，妊娠早期，她在6小时内开始出现恶心和呕吐超过15次，伴有吞咽痛、声音嘶哑和颈部疼痛，上个月体重减轻5公斤。体格检查显示患者状况不佳，脱水，颈部肿胀且有皮下气肿，胸部可闻及湿啰音。实验室检查发现低钾血症、白细胞增多、急性肾衰竭和肝酶升高。初始治疗包括静脉补液复苏、恢复水电解质平衡、止吐治疗和休息，进行了颈部和胸部的CT检查，排除了任何喉和食管损伤及穿孔，但显示纵隔内有气体。保守治疗后病情好转，7天内完全康复。
医生必须牢记不同的诊断，并在出现对母亲有潜在致命风险的并发症时及时做出决策，这非常重要。
