A 32-Year-Old Primigravida at 18 Weeks Gestation Is Evaluated in the Emergency

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

A) Acute fatty liver of pregnancy
B) HELLP syndrome
C) Late neurosyphilis
D) Thiamine deficiency
E) Vitamin B₁₂ deficiency

Correct Answer:

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