Co esponding au ho : Chika Thompson Ugwunayi. Email:
Copy igh © 2025 Au ho (s) e ain he copy igh o his a icle. This a icle is published unde he e ms o he C ea i e Commons A ibu ion License 4.0.
Hype emesis Induced Acu e Quad ipa esis in P egnancy wi h Missed Misca iage: A
Case Repo
Emeka Kel in O uanya 1, 2, Chika Thompson Ugwuanyi 1, *, I eanyi Johnson Onyekpa 1, 2, Sunday Gab iel Mba 1, 2,
Uwaezuoke Boni ace Odugu 1, 2, Obio a Calis us Ne o 1, 2, Malachy Ezenwaeze Nwaeze 1, 2, Onyegbunam Sil es e
Nweze 1, 2, Chike Joachim Maduka 1, 2, Ikenna F ed ick Awkadigwe 1, Chijioke Obiechina Eze 1, Nnamdi Vi alis
Udeozo 1, Chukwuka Chude Eze 1, Godwin Ugochukwu Emmanuel 1, Chibunze Chukwunonso Udegbunam 1,
Da ling on Sunday Sochima Okoh 1, Ma hew Okoh 1, Ogbonna Thadeus O o 1, Ejio o Enoch Ogbonna 1,
Chukwunonso Nnabuike O one e 1, Ijeoma E nes Uzoho 1, Chukwubuike Obumnaeme Nkemakolam 1, Ukamaka
And e Ezike 1, Mekowulu Chigekwu Nwanne 1 and Chibuzo Da ling on-Pe e Ugoji 3
1 Depa men o Obs e ics and Gynaecology, Enugu S a e Uni e si y Teaching Hospi al, Pa klane, Enugu, Nige ia.
2 College o Medicine, Enugu S a e Uni e si y o Science and Technology Enugu, Nige ia.
3 Depa men o Obs e ics and Gynaecology, Da id Umahi Fede al Uni e si y Teaching Hospi al Ubu u, Ebonyi S a e,
Nige ia.
Wo ld Jou nal o Biology Pha macy and Heal h Sciences, 2025, 24(01), 053-056
Publica ion his o y: Recei ed on 25 Augus 2025; e ised on 01 Oc obe 2025; accep ed on 03 Oc obe 2025
A icle DOI: h ps://doi.o g/10.30574/wjbphs.2025.24.1.0871
Abs ac
Repo s on quad ipa esis in p egnancy seconda y o gas oin es inal losses a e a e. We desc ibe a p e iously heal hy
22-yea -old p imig a ida a app oxima ely 20 weeks ges a ion who p esen ed o us wi h weakness in all he ou limbs
o 3 days and omi ing o and on in he las 6 weeks ges a ion. This epo is unusual bu impo an as i is a apidly
ea able o e e sible pa esis. He ein his epo .
Keywo ds: Hypokalemic; Hype emesis G a ida um; P egnancy; Quad ipa esis; Re e sible
1. In oduc ion
Hype emesis g a ida um (HG) is pe sis en and excessi e omi ing s a ing be o e he end o he 22nd week o
ges a ion, leading o ca bohyd a e deple ion, dehyd a ion and elec oly e imbalance as de ined by he In e na ional
S a is ical Classi ica ion o Disease and Rela ed Heal h P oblems, 10 h Re ision.1 I occu s in 0.3-10.8% o
p egnancies.2Un il he 1950’s, ma e nal dea hs we e commonly caused by hype emesis g a ida um.3Mo bidi y and
mo ali y associa ed wi h un ecognized disease include espi a o y ailu e, ca diac a es , We nicke's Encephalopa hy
and Ko sako 's Psychosis, pulmona y embolism and dea h4-9 om malnu i ion, dehyd a ion and elec oly e.
Hypokalaemia om hype emesis g a ida um can lead o acu e hypokalaemic pa alysis which is an uncommon cause o
acu e weakness. Hence, i is impe a i e o physicians o be knowledgeable abou he causes o hypokalemic pa alysis,
and conside hem diagnos ically. The hypokalaemic pa alyses ep esen a he e ogeneous g oup o diso de s wi h a
inal common pa hway p esen ing as acu e weakness and hypokalaemia. Mos cases a e due o amilial hypokalaemic
pa alysis,10 howe e , spo adic cases a e associa ed wi h di e se unde lying e iologies including gas oin es inal
po assium losses as is he case in ou pa ien , hy o oxic pe iodic pa alysis, ba ium poisoning, enal ubula acidosis,
p ima y hype aldos e onism and lico ice inges ion. The app oach o he pa ien wi h hypokalemic pa alysis includes a
igo ous sea ch o he unde lying e iology and po assium eplacemen he apy. Fu he he apy depends on he
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e iology o he hypokalemia. Disposi ion depends on se e i y o symp oms, deg ee o hypokalemia, and ch onici y o
disease.10
2. Case Repo
We desc ibe a p e iously heal hy 22-yea -old p imig a ida whose i s day o he Las Mens ual Pe iod (LMP) was 27
July 2023 and p esen ed a 20 weeks + 1 day ges a ion wi h weakness in all he ou limbs 3 days p io o he
p esen a ion and omi ing which was o and on o 6 weeks ges a ion. She had no di icul y in espi a ion o swallowing
o weakness o ace and neck muscles. The e was no his o y o auma, e e , headache, ecen dia hea, neck-pain,
lowe u ina y ac symp oms and p e ious such episodes p io o onse o weakness. He pa en s and siblings had no
his o y o simila episode o any o he signi ican illness. The e was no his o y o he use o co icos e oid p io o
p esen a ion. On admission she was a eb ile wi h a empe a u e o 36.5OC, dehyd a ed wi h a pulse a e o 100
bea s/minu e and a blood p essu e o 100/70 mmHg. She was conscious and o ien ed o ime, place and pe son
howe e powe in all he ou limbs we e g ade 2 by MRC (Medical Resea ch Council) scale wi h diminished deep endon
e lexes in bo h uppe and lowe limbs and no mal plan a e lexes. C anial ne e unc ions we e in ac and so was he
senso y unc ion. Guillain-Ba e synd ome was uled ou . Examina ion o espi a o y sys em and ca dio ascula sys em
was un ema kable.
Abdominal examina ion e ealed u e us o 18–20-week size. The abdominopel ic Ul asonog aphy pe o med showed
missed misca iage and she had medical e acua ion wi hou complica ions. Compu ed omog aphy (CT) scan o he
b ain as well as Magne ic Resonance imaging (MRI) o he spine we e all essen ially no mal. He o al whi e blood cell
coun was no mal as well as he pla ele s.
She was adminis e ed in a enous luids and gi en suppo i e managemen keeping in iew omi ing and dehyd a ion.
The biochemical p o ile epo a he ime o admission e ealed a e y low se um po assium le els o 1.0 mmol/L (as
shown in Figu e 1). Thy oid p o ile was no mal. In a enous po assium was eplaced which led o emission o
symp oms. He powe imp o ed and she was discha ged a e 3 weeks o hospi aliza ion wi h po assium supplemen s
and physio he apy and was ad ised equen ollow ups o ma e nal wellbeing and p econcep ion ca e. The se um
po assium le el a discha ge was 3.9mmol/L (Figu e 2).
Figu e 1 Resul s o se um elec oly e and c ea inine a admission
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Figu e 2 se um elec oly e wi h no mal po assium le el a discha ge
3. Discussion
Hype emesis g a ida um is a se e e clinical disease in p egnancy whe e pa ien s ha e in ac able nausea and omi ing
wi h inc eased mo bidi y and e en mo ali y.10Inco ec diagnosis and imp ope managemen can lead o ma e nal
ca diac a es and ma e nal dea h.6,9 In hype emesis g a ida um, a ely, pa ien s p esen wi h se e e i amin
de iciency, causing a neu ological eme gency called We nicke’s encephalopa hy7Though his was no seen in ou
pa ien . Ou pa ien p esen ed wi h complain s o p o ac ed nausea and omi ing, dehyd a ion, elec oly e
abno mali ies, and a weigh loss o o e 5% o he p e-p egnancy weigh wi h weakness in ol ing he ou limbs and
missed misca iage. The occu ence o elec oly e abno mali ies, hypokalaemia in pa icula in his condi ion is he
cause o laccid pa alysis. A simila hypokalaemia wi h missed misca iage was epo ed by Suwanwongse and his
colleague in Lincoln Medical Cen e , New Yo k Ci y, USA,11 howe e , he p esen ing po assium le el was 2.8mmol/L
which was highe han he alue o 1.0 mmo/L seen in ou pa ien . The in ac able omi ing was o a du a ion o 2
days11 which was sho e compa ed o a du a ion o o e 6 weeks expe ienced in ou pa ien . A case o hypokalaemic
laccid pa alysis wi h ype 2 espi a o y ailu e due o hype emesis g a ida um wi h a po assium le el o 1.8 mmol/L
was epo ed by Naik and his s udy g oup in India.5 The hy oid p o ile es s showed hype hy oidism and would ha e
accoun ed o he mani es a ion o ype II espi a o y ailu e which was absen in ou pa ien who ha d no mal hy oid
unc ion p o ile. Ano he case o seconda y hypokalaemic non-pe iodic pa alysis ollowing he use o co icos e oid due
o in ac able nausea and omi ing o p egnancy was epo ed by Khan and his colleagues.12This was no he case in
ou pa ien as she did no use co icos e oid be o e she de eloped quad ipa esis. Gup a and his colleague equally
epo ed hype emesis induced acu e quad ipa esis in a 22-yea -old p imig a ida a app oxima ely 20 weeks ges a ion
who p esen ed wi h weakness in all he ou limbs o 3 days du a ion and omi ing o and on o 6 weeks. The
biochemical p o ile a he ime o admission e ealed a e y low po assium le els o 1.42 mEq/L. Thy oid p o ile was
no mal. She had in a enous po assium eplacemen which led o emission o symp oms and p egnancy con inued
une en ully. He powe imp o ed and she was discha ged wi h po assium supplemen s.13 This case scena io was
almos simila o wha ob ained in ou pa ien who was also a 22 yea old p imig a ida, de eloped quad ipa esis a
abou same ges a ional age o 20 weeks + 1 day and wi h simila du a ion and pa e n o nausea and omi ing howe e
he e was no misca iage p obably due o a bi highe le el o se um po assium compa ed o a e y low le el o se um
po assium ob ained in ou pa ien .
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4. Conclusion
Hypokalemia in Hype emesis g a ida um is a li e- h ea ening condi ion and delay in he diagnosis may lead o laccid
pa alysis. S ic and egula elec oly e moni o ing and ea ly co ec ion o po assium will a e he associa ed mo ali y.
Timely in e en ion by po assium supplemen a ion co ec ed he hypokalaemia and he pa ien eco e ed om his
nea miss e en .
Compliance wi h e hical s anda ds
Acknowledgemen s
The au ho s acknowledged he suppo s and assis ance om he adiology, and especially he labo a o y depa men s
o hei e o s in he pa ien ’s moni o ing and ollow up.
S a emen o E hical app o al
This case epo is exemp om e hical app o al in ou ins i u e
Disclosu e o con lic o in e es
The e was no con lic o in e es o decla e.
S a emen o in o med consen
In o med consen was ob ained om he pa ien whose case was epo ed.
Re e ences
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