History ‘A 28-year-old Asian woman is referred by her general practitioner (GP) with persistent vomiting at 7 weeks’ gestation. She is in her second pregnancy having had a normal vagi- nal delivery 3 years ago. She is now vomiting up to 10 times in 24h, and has not man- aged to tolerate any food for 3 days. She can only drink small amounts of water. She saw her GP 2 week ago who prescribed prochlorperazine suppositories but these only helped for a few days. She feels very weak in herself and is unable to care for her son now. On direct questioning she has upper abdominal pain that is constant, sharp and burning. She has not opened her bowels for 5 days. She is passing small amounts of dark urine infrequently but there is no dysuria or haematuria. There has been no vaginal bleeding. There is no other medical or gynaecological history of note except that she suffered per- sistent vomiting in her first pregnancy requiring two overnight admissions. Examination She is apyrexial. Lying blood pressure is 115/68mmHg and standing blood pressure 98/55 mmHg. Heart rate is 96/min. The mucus membranes appear dry. Abdominal exam- ination reveals tenderness in the epigastrium but no lower abdominal tenderness. The uterus is not palpable abdominally. | Al tnvestiGations ‘Normal range for pregnancy Haemoglobin Wa g/dl 1-14 yb Mean cell volume soi 744-9511 White cell count 8.9 x 10°. 6-16 x 10% Platelets 298 x 10% 150-400 x 10%. Sodium 131 mmolA. 130-140 mmol/. Potassium 3.0mmol/. 3.3-4.1 mmolA Urea 8.2mmol/L 2.4-4.3 mmolA Geatinine 65 moll 34-82 moll. Alanine transaminase 301U/L 6-321U/. Alkaline phosphatase 2761UIL 30-300 IU/L Gamma glutamyl transaminase 17 IU/L S-431U/L Bilirubin wt 3-14ymoll. Albumin 34g 28-37 gf Pregnancy test: positive Urinalysis: protein negative; blood negative; nitrites negative; leucocytes negative; +++ ketones; glucose negative