Clinical Case 1

Sarah is a 32-year-old female who is eight weeks pregnant. This is her second pregnancy, and she developed Hyperemesis Gravidarum during her first pregnancy. She has been vomiting intermittently for the last two weeks but had been managing this at home with oral cyclizine. She has no significant past medical history and is not on any other medication, beyond the cyclizine.

Today she has had a significant increase in her symptoms with nausea for the last eight hours. She has vomited 12 times today so far, but over the last few hours has had five episodes of dry retching.

When you assess her, she appears to have dry mucus membranes and the following observations:

• HR 118
• BP 105/82
• RR 15
• Temp 36.4
• Saturations 99% on room air

You can see that at triage she was prescribed some of her usual oral cyclizine but she tells you that she immediately vomited this up.