Hyperemesis gravidarum

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:

Clinical Features

  • Signs of volume depletion
  • Abdominal pain is highly unusual and if present suggests a different diagnosis

Work-Up

  1. CBC
  2. Chemistry
  3. UA

DDx

Treatment

  1. IVF (use fluid containing 5% glucose to reverse ketonuria)
  2. Antiemetics
    1. Ondansetron 8mg IV or 4mg PO TID[1]
    2. Promethazine 25-50mg IV q4hr
  3. Alternative Medications
    1. Ginger 1-1.5g PO divided BID-QID
    2. Diclegis
    3. Antihistamines (1st line tx Diphenhydramine, Meclizine, Dimenhydrinate)

Disposition

  1. Discharge if ketonuria reversed and pt able to tolerate PO
  2. Admit if:
    1. Uncertain diagnosis
    2. Intractable vomiting
    3. Persistent ketone or electrolyte abnormalities after volume repletion
    4. Wt loss >10% of prepregnancy weight

Source

Tintinalli

  1. “Ondansetron Compared With Metoclopramide for Hyperemesis Gravidarum A Randomized Controlled Trial” http://www.ncbi.nlm.nih.gov/pubmed/24807340