Hyperemesis gravidarum

Background

Clinical Features

Note: Abdominal pain is highly unusual and should prompt consideration of a different diagnosis

Differential Diagnosis

Nausea and vomiting in pregnancy

Evaluation

Workup

  • Urinalysis for ketones
  • Chemistry
    • May show signs of dehydration, hypokalemia
  • CBC

Management

Rehydration

  • PO fluids if able to tolerate
  • IV fluid repletion (use D5NS in the setting of ketonuria)

Antiemetics

ACOG recommends a stepwise approach to nausea and vomiting in pregnancy[4]

Medication Pregnancy Drug Class
Vitamin B6 A
Dimenhydrinate B
Doxylamine A
Ondansetron C
Metoclopramide B
Promethazine C

Disposition

References

  1. Goodwin, TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am. 2008 Sep;35(3):401-17
  2. Kantor S, Prakash S, Chandwani J, Gokhale A, Sarma K, Albahrani MJ. Wernicke's encephalopathy following hyperemesis gravidarum. Indian J Crit Care Med. 2014;18(3):164–166. doi:10.4103/0972-5229.128706
  3. Kotha VK, De Souza A. Wernicke's encephalopathy following Hyperemesis gravidarum. A report of three cases. Neuroradiol J. 2013;26(1):35–40. doi:10.1177/197140091302600106
  4. Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 153. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015; 126(3):e12-24
  5. Fejzo MS, et al. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States. Reprod Toxicol. 2016 Jul;62:87-91.