83

83 CASE 83


A pregnant 34-year-old woman arrives in the emergency department by ambulance after suffering a seizure while waiting in the optometrist’s office.


The patient is at 29 weeks’ gestation, and this is her third pregnancy. She has a history of hypertension and diabetes but managed these conditions well during her previous pregnancies. However, with this pregnancy, she experienced excessive swelling in comparison to the past two and reports a decrease in urine production. The patient had an acute decrease in visual acuity 2 days ago and had a seizure while in the waiting room at the optometrist’s office. She arrived at the emergency department 45 minutes later.



PHYSICAL EXAMINATION



VS: T 98°F, P 100/min, R 20/min, BP 160/110 mm Hg

PE: The patient is anxious and recovering from the unexpected seizure. Ophthalmoscope shows retinal hemorrhage. The patient has edema of the hands and feet. The remainder of the physical examination is appropriate for a 29-week gestation.


LABORATORY STUDIES



Ultrasonography: Fetal growth restriction

Blood tests:
• Platelets: 80,000/mL (normal: 150,000-350,000/mL)

• Aspartate aminotransferase: 80 IU/L (normal: 7-27 IU/L)

• Lactate dehydrogenase: 650 IU/L (normal: 50-150 IU/L)

• Alanine aminotransferase: 40 IU/L (normal: 1-21 IU/L)

• Uric acid: 12 mg/dL (normal 2-7 mg/dL)

• Fasting blood glucose level: 105 mg/dL (normal: 70-110 mg/dL)

24-hour urine collection:
• 300 mL (normal: > 500 mL/24 hr)

• 8 g protein (normal: < 1 g/24 hr)


DIAGNOSIS


Eclampsia

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Jul 4, 2016 | Posted by in PHYSIOLOGY | Comments Off on 83

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