[Bulimia, induced vomiting, hypochloremic-hypokalemic alkalosis and fetal distress in the 33rd week of pregnancy. Obstetric and anesthesiologic management].

A 39-year-old primigravida was admitted to the hospital in the 33rd week of pregnancy due to fetal retardation and placental insufficiency, malnutrition, decreased cutaneous turgor, and cardiotocographic (CTG) fetal distress. Body weight had increased subnormally through the 29th week of gestation and had since decreased by 2.5 kg. The following laboratory tests were obtained (normal values for pregnant women in parentheses): serum bicarbonate 50.9 (20-24) mmol/l, pH 7.61 (7.4), PCO2 52.4 (31) mmHg, SaO2 89-91 (greater than 95%); serum sodium 125 (137-145), potassium 1.8 (3.6-5.5), chloride 55 (94-111) mmol/l; colloid osmotic pressure 20.7 (19-22) mmHg. A decompensated hypochloremic-hypokalemic acidosis together with hypovolemic, isotonic hyponatremia was diagnosed and bulimic vomiting that had existed for two decades was discovered as the underlying cause. The acute therapy was aimed at normalization of the fluid-electrolyte status, oxygenation, utero-placental perfusion, and placental-fetal O2 transfer and was carried out under close clinical, biochemical, and CTG surveillance. In addition to the basic measures (lateral tilt position, nasal O2 application, isotonic electrolyte solutions, parenteral nutrition), 158 mmol H+, 240 mmol K+, and 414 mmol Na+ ions were administered. This therapy improved the maternal and fetal parameters continuously (Table 3, Fig. 1). Twenty-six hours following the initiation of treatment, a cesarean section was performed after induction of catheter-epidural anesthesia.