A 32-year-old primigravida at 28 weeks of gestation presents with blood pressure 152/98 mmHg on two occasions 4 hours apart. Urinalysis shows 2+ proteinuria. Which of the following is NOT a recognized feature of preeclampsia?

Question

Accepted Answer

D. Hypercalcemia (>10.5 mg/dL). ## Diagnostic Criteria and Features of Preeclampsia

**Key Point:** Preeclampsia is defined by new-onset hypertension (≥140/90 mmHg) after 20 weeks gestation plus proteinuria (≥0.3 g/24 h) or signs of end-organ dysfunction. Hypercalcemia is NOT a feature; in fact, hypocalcemia may occur.

### Recognized Features of Preeclampsia

| Feature | Mechanism | Clinical Significance |
|---------|-----------|----------------------|
| Hyperreflexia + ankle clonus | Cerebral edema, hyperexcitability | Sign of severe disease; eclampsia risk |
| Elevated serum creatinine | Renal endothelial dysfunction, reduced GFR | Indicates renal involvement |
| Thrombocytopenia | Platelet consumption, HELLP syndrome | <100,000/μL = severe feature |
| Hypocalcemia (NOT hypercalcemia) | Increased urinary losses, altered metabolism | May worsen neuromuscular irritability |

**High-Yield:** The HELLP syndrome triad (Hemolysis, Elevated Liver enzymes, Low Platelets) is a severe manifestation of preeclampsia, NOT a separate entity. Thrombocytopenia is a cardinal sign.

**Clinical Pearl:** Hypercalcemia is associated with hyperparathyroidism and malignancy, NOT preeclampsia. Students often confuse mineral metabolism in pregnancy — remember that preeclampsia causes *reduced* calcium reabsorption and *increased* urinary losses.

**Warning:** Do not confuse hypocalcemia (seen in preeclampsia/eclampsia) with hypercalcemia (seen in granulomatous diseases, malignancy, vitamin D toxicity).

Answer

A. Hyperreflexia with ankle clonus

Answer

B. Thrombocytopenia (<100,000/μL)

Answer

C. Elevated serum creatinine (>1.1 mg/dL)

A 32-year-old primigravida at 28 weeks of gestation presents with blood pressure 152/98 mmHg on two occasions 4 hours apart. Urinalysis shows 2+ proteinuria. Which of the following is NOT a recognized feature of preeclampsia?

Explanation

Diagnostic Criteria and Features of Preeclampsia

Recognized Features of Preeclampsia

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Feature	Mechanism	Clinical Significance
Hyperreflexia + ankle clonus	Cerebral edema, hyperexcitability	Sign of severe disease; eclampsia risk
Elevated serum creatinine	Renal endothelial dysfunction, reduced GFR	Indicates renal involvement
Thrombocytopenia	Platelet consumption, HELLP syndrome	<100,000/μL = severe feature
Hypocalcemia (NOT hypercalcemia)	Increased urinary losses, altered metabolism	May worsen neuromuscular irritability