Respiratory Arrest in an Obese Pregnant Woman with Hyperemesis Gravidarum

Abstract

A pregnant, non-Japanese-speaking Peruvian, and, thus, with communication difficulty, suffered hyperemesis gravidarum and had respiratory arrest, requiring cardiopulmonary resuscitation. The obese pregnant woman (prepregnancy weight: 107 kg) had vomited and lost 15 kg in bodyweight over appropriately 2 weeks prior to the arrest but had not complained due to communication difficulty, which, together with her obesity, prevented a Japanese obstetrician from noticing her severe condition. 1,000 mL of low potassium fluid plus thiamine was administered. She became unable to stand, suggesting lower-extremity-proximal-muscle weakness, and then respiratory arrest occurred. Hypopotassemia (2.3 mEq/L), pulseless electrical activity, and muscle weakness suggested the presence of severe potassium deficiency, which may have caused respiratory muscle paralysis, leading to the respiratory arrest. Hypercapnea was severer than expected for compensatory hypoventilation, indicating the presence of concomitant severe hypoventilation, which may also have contributed to respiratory arrest. She recovered with electrolyte and volume replacement. Respiratory arrest can occur with hyperemesis gravidarum, and obesity and communication difficulties can prevent the early detection of severe conditions.

Gestational Malnutrition is Still the Skeleton in the Closet: Where Are the Malnutrition Risk Screening Criteria?

“…While we could find no numerical definition for "rare", to date the number of HG-WE cases totals 216. HG-related Injuries include the physical damage which is likely induced by the pneumatic forces of retching and vomiting which can result in splenic avulsion, esophageal rupture, and subluxation of the orbit, those due to severe dehydration manifesting in acute renal failure, deep vein thrombosis, pancreatitis, and those which result from gross under-nourishment, culminating in WE (a lack of vitamin B1, thiamin, magnesium, and phosphorus), hemorrhage and bleeding issues resulting from vitamin K deficiency, cardiac and respiratory arrest due to electrolyte deficiencies as well as death from extreme weight loss [50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65][66]. The patient presented with 2 months of daily emesis, ataxia, hypokalemia (2.5 mEq/L), 2 episodes of seizures in the prior week and elevated liver function tests.…”

Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor

“…Although the prevalence of OHS is increasing in the obstetric population and OHS is known to increase risk for perioperative morbidity and mortality [ 16 ], there are limited reports of obstetric patients with OHS. We found only one case report describing OHS during pregnancy, in which a parturient with obesity-related hypoventilation and hypercarbia had cardiac arrest after developing severe hypokalemia due to hyperemesis gravidarum [ 17 ]. By contrast, increased attention is being paid to the diagnosis and treatment of OSA during pregnancy.…”

Profound Hypokalaemia Resulting in Maternal Cardiac Arrest: A Catastrophic Complication of Hyperemesis Gravidarum?

“…There is a case report by Iwashita [ 10 ] that attributes hypokalaemia second to HG as a cause of arrest and maternal death. The authors report on an obese pregnant woman who suffered a respiratory arrest at 12+4 weeks' gestation that was attributed to severe HG causing profound hypokalaemia.…”

“…The authors report on an obese pregnant woman who suffered a respiratory arrest at 12+4 weeks' gestation that was attributed to severe HG causing profound hypokalaemia. They attributed the respiratory arrest to severe potassium deficiency causing respiratory muscle paralysis and this was compounded by obesity [ 10 ].…”