A severe hypotensive response to parenterally administered reserpine occurred in a patient with mild toxemia of pregnancy. Later, when the effect of the reserpine had diminished considerably, cardiac arrest developed. Some hours after resuscitation, the patient died and was found at necropsy to have fatty metamorphosis of the liver. Acute fatty metamorphosis of the liver in pregnancy is an uncommon lesion. The principal histologic finding was a foamy vacuolar type of fatty change involving the central portion of the liver lobules. Liver disease was unsuspected in this patient because of the absence of jaundice. The possibility of liver disease should be entertained whenever persistent nausea and vomiting develop in the latter part of pregnancy, especially when severe toxemia and pyelonephritis can be excluded.
