Hyperemesis gravidarum: Difference between revisions
m (Rossdonaldson1 moved page Hyperemesis Gravidarum to Hyperemesis gravidarum) |
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==Background== | ==Background== | ||
*Simple | *Simple [[nausea and vomiting]] affects 60-80% of pts during first 12wk of pregnancy | ||
*Hyperemesis gravidarum defined as intractable vomiting with at least 1 of following: | *Hyperemesis gravidarum defined as intractable vomiting with at least 1 of following: | ||
**Wt loss | **Wt loss | ||
**Volume depletion | **Volume depletion | ||
**Hypokalemia | **[[Hypokalemia]] | ||
**Ketonemia | **Ketonemia | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 19: | Line 17: | ||
==DDx== | ==DDx== | ||
*Gestational trophoblastic disease (may present with intractable vomiting) | |||
*[[Thryotoxicosis]] (may present with intractable vomiting) | |||
*[[Biliary disease]] | |||
*[[Ectopic pregnancy]] | |||
*[[Gastroenteritis]] | |||
*[[Pancreatitis]] | |||
*[[Appendicitis]] | |||
*[[Hepatitis]] | |||
*[[Peptic ulcer disease]] | |||
*[[Pyelonephritis]] | |||
*Fatty liver of pregnancy | |||
*[[HELLP syndrome]] | |||
==Treatment== | ==Treatment== | ||
#IVF (use fluid containing 5% glucose to reverse ketonuria) | #IVF (use fluid containing 5% glucose to reverse ketonuria) | ||
#Antiemetics | #Antiemetics | ||
## | ##[[Ondansetron]] 8mg IV or 4mg PO TID<ref>“Ondansetron Compared With Metoclopramide for Hyperemesis Gravidarum | ||
A Randomized Controlled Trial” | A Randomized Controlled Trial” | ||
http://www.ncbi.nlm.nih.gov/pubmed/24807340</ref> | http://www.ncbi.nlm.nih.gov/pubmed/24807340</ref> | ||
##Promethazine 25-50mg IV q4hr | ##[[Promethazine]] 25-50mg IV q4hr | ||
#Alternative Medications | #Alternative Medications | ||
##Ginger 1-1.5g PO divided BID-QID | ##Ginger 1-1.5g PO divided BID-QID | ||
##Diclegis | ##Diclegis | ||
##Antihistamines (1st line tx Diphenhydramine, Meclizine, Dimenhydrinate) | ##[[Antihistamines]] (1st line tx Diphenhydramine, Meclizine, Dimenhydrinate) | ||
==Disposition== | ==Disposition== | ||
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#Admit if: | #Admit if: | ||
##Uncertain diagnosis | ##Uncertain diagnosis | ||
##Intractable vomiting | ##Intractable [[vomiting]] | ||
##Persistent ketone or electrolyte abnormalities after volume repletion | ##Persistent ketone or [[electrolyte abnormalities]] after [[volume repletion]] | ||
##Wt loss >10% of prepregnancy weight | ##Wt loss >10% of prepregnancy weight | ||
Revision as of 17:33, 22 September 2014
Background
- Simple nausea and vomiting affects 60-80% of pts during first 12wk of pregnancy
- Hyperemesis gravidarum defined as intractable vomiting with at least 1 of following:
- Wt loss
- Volume depletion
- Hypokalemia
- Ketonemia
Clinical Features
- Signs of volume depletion
- Abdominal pain is highly unusual and if present suggests a different diagnosis:
Work-Up
- CBC
- Chemistry
- UA
DDx
- Gestational trophoblastic disease (may present with intractable vomiting)
- Thryotoxicosis (may present with intractable vomiting)
- Biliary disease
- Ectopic pregnancy
- Gastroenteritis
- Pancreatitis
- Appendicitis
- Hepatitis
- Peptic ulcer disease
- Pyelonephritis
- Fatty liver of pregnancy
- HELLP syndrome
Treatment
- IVF (use fluid containing 5% glucose to reverse ketonuria)
- Antiemetics
- Ondansetron 8mg IV or 4mg PO TID[1]
- Promethazine 25-50mg IV q4hr
- Alternative Medications
- Ginger 1-1.5g PO divided BID-QID
- Diclegis
- Antihistamines (1st line tx Diphenhydramine, Meclizine, Dimenhydrinate)
Disposition
- Discharge if ketonuria reversed and pt able to tolerate PO
- Admit if:
- Uncertain diagnosis
- Intractable vomiting
- Persistent ketone or electrolyte abnormalities after volume repletion
- Wt loss >10% of prepregnancy weight
Source
Tintinalli
- ↑ “Ondansetron Compared With Metoclopramide for Hyperemesis Gravidarum A Randomized Controlled Trial” http://www.ncbi.nlm.nih.gov/pubmed/24807340