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:
- 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