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首页> 外文期刊>Journal of Emergency Medicine, Trauma and Acute Care >A lady with repeated vomiting - unexpected diagnosis
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A lady with repeated vomiting - unexpected diagnosis

机译：一位女士反复呕吐-意外诊断

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Background: Vomiting is a symptom commonly encountered in emergency settings, with many differential diagnoses. In the following case, the diagnosis was nearly missed and the outcome could have been critical. Methods: A case study was performed, supported by literature review. A 32 year-old lady presented to the Emergency Department with repeated vomiting for one day. She has had epigastric discomfort for several days. Her blood pressure was 119/74?mmHg, heart rate 118/minute, and she was afebrile. She had been under the in-vitro fertilisation program and received human chorionic gonadotrophin, oocyte retrieval and embryo transfer 8, 6, and 3 days respectively prior to presentation. On examination, her abdomen was soft, non-tender. Urinary pregnancy test was negative. Her sodium level was 131?mmol/l, Hb 17.0?g/dL, white cell count 20.5 × 10*9/L, and platelet 485 × 10*9/L. The rest of the renal and liver functions and amylase, were normal. She was admitted to the Emergency Ward with a working diagnosis of gastritis. On reassessment, her abdomen was noted to be slightly distended although no tenderness or guarding was elicited. Ovarian hyperstimulation syndrome was suspected, and gynaecology was consulted for further evaluation. Results: Transvaginal ultrasound scan showed a normal-sized uterus with thickened endometrium and no intrauterine sac. Both ovaries were enlarged, left ovary 6.1 × 4.3?cm and right ovary 5.0 × 5.3?cm. Significant pelvic free fluid was present. The diagnosis was confirmed to be early ovarian hyperstimulation syndrome. Ovarian hyperstimulation syndrome is an iatrogenic complication from assisted reproduction technology. Following gonadotropin therapy, this condition usually develops several days after oocyte retrieval or assisted ovulation, with ovarian enlargement due to multiple ovarian cysts. Complications include ascites, haemoconcentration, hypovolaemia, and electrolyte imbalances. Conclusion: Emergency physicians should consider ovarian hyperstimulation syndrome in patients who had received assisted reproduction presenting with repeated vomiting.
机译：背景：呕吐是紧急情况下经常遇到的一种症状，有许多鉴别诊断。在以下情况下，诊断几乎被漏诊，结果可能很关键。方法：在文献综述的支持下进行了案例研究。一名32岁的女士出现在急诊室，反复呕吐一天。她有几天胃dis不适。她的血压为119 / 74mmHg，心律为118 /分钟，并且有发热。她一直在进行体外受精程序，并在出现前分别于第8、6和3天接受了人绒毛膜促性腺激素，卵母细胞取回和胚胎移植。经检查，腹部柔软，无压痛。尿妊娠试验阴性。她的钠水平为131？mmol / l，血红蛋白为17.0？g / dL，白细胞计数为20.5×10 * 9 / L，血小板为485×10 * 9 / L。其余的肾，肝功能和淀粉酶均正常。她被诊断出患有胃炎，被送入急诊病房。重新评估后，尽管没有压痛或保持警惕，但腹部仍被轻微张开。怀疑有卵巢过度刺激综合症，并请妇科进行进一步评估。结果：经阴道超声检查显示子宫大小正常，子宫内膜增厚，无子宫内囊。两个卵巢均增大，左卵巢6.1×4.3？cm，右卵巢5.0×5.3？cm。存在大量骨盆游离液。该诊断被证实为早期卵巢过度刺激综合征。卵巢过度刺激综合征是辅助生殖技术的医源性并发症。促性腺激素治疗后，这种情况通常会在卵母细胞取回或辅助排卵后数天发展，由于多个卵巢囊肿，卵巢增大。并发症包括腹水，血液浓缩，低血容量和电解质失衡。结论：急诊医师应考虑接受辅助生殖并反复呕吐的患者的卵巢过度刺激综合征。

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