A Dangerously Gassy Pregnancy

Abstract

Case Presentation

An 18-year-old G1P0 woman at 9 weeks gestation with no known medical history presented to the ED with complaints of chest pain, shortness of breath, nausea, and vomiting. Nausea and vomiting had been present for 4 weeks and occurred multiple times daily, and the chest pain and shortness of breath had been present intermittently over the past 3 weeks but had worsened 2 days before admission. Chest pain severity was rated 10/10, was made worse with movement, and was associated with increasing shortness of breath. Vomitus was described as brown, occurring multiple times per day, and having no association with oral intake. The patient’s last menstrual cycle was reported to be approximately 3 months earlier, with the exact date unknown. She was evaluated at an outside hospital 1 week before admission for similar complaints. She did not use tobacco and denied recreational drug use. Physical examination showed BP of 105/58 mm Hg, heart rate of 138 beats/min, and normal oxygen saturation on room air without tachypnea. The patient was neurologically intact. Palpation of the chest wall was notable for crepitus, and breath sounds were decreased bilaterally. The patient was moderately hyponatremic and severely hypokalemic, and urine was positive for elevated ketones. An infectious workup, including leukocyte count, blood cultures, and urinalysis, was negative. Urine drug screen was negative. Transvaginal ultrasounds confirmed a single living intrauterine gestation at 9 weeks 4 days.