QUESTION 30

 A 32-year-old primigravida at 18 weeks gestation is evaluated in the emergency department for increasing confusion and

incoherence. Her husband says that she has become increasingly unsteady while standing and has fallen twice. The patient was

previously seen in the emergency department for nausea and vomiting and was treated with intravenous fluids and antiemetics.

Although she continues to take oral antiemetics, she has had persistent vomiting and has lost 7 kg (154 lb) of her prepregnancy

weight Blood pressure is 110/60 mm Hg and pulse is 98/min. Fetal heart tones are 155/min. Physical examination shows

nystagmus but no scleral icterus. Pupils are equal and reactive to light and accommodation. Abdominal examination shows

epigastric pain but no rebound or involuntary guarding The patient has trace pedal edema over her bilateral lower extremities and

bilaterally absent ankle reflexes. Laboratory results are as follows:

Complete blood count

Hematocrit36%

Mean corpuscular volume84 fl

Platelets240.000/mm3

Leukocytes10,000/mm3

Serum chemistry

Sodium131 mEq/L

Potassium3.2 mEq/L

Chloride90 mEq/L

Bicarbonate 36 mEq/L

Blood urea nitrogen 18 mg/dl

Creatinine 0.8 mg/dl

Glucose 70 mg/dl

Aspartate aminotransferase (SGOT) 110 U/L

Alanine aminotransferase (SGPT) 114 U/L

Lipase 32 U/L

Which of the following is the most likely diagnosis in this patient?

QA Acute fatty liver of pregnancy

0 B. HELLP syndrome

0 C. Late neurosyphilis

0 D. Thiamine deficiency

0 E. Vitamin B,2 deficiency