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- Hyperemesis gravidarum
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Hyperemesis gravidarum
Main and Danish guidelines by the web master
Incidence: 0.1-1% of pregnancies. Findings:
-
Nausea, vomiting and there may be ptyalism (excessive salivation).
Normally from 6-16 weeks, maximum 8-12 weeks.
Severity correlated to hCG and biochemical hyperthyroidism. Weight loss > 5%.
Prefunderance of femal fetures. Conflicting evidence of the role of helicobacter pyleri Dehydration with hyponatremia, < 120 mmol can cause seizures, spastic parous and extremely seldom respiratory failure (osmotic demyelinisation syndrome).
Hypokalemia. Metabolic hypochloremic alkalosis. Low serum urea.
Vitamin deficiencies, B12 and B6.
Mallory-Weiss tears of the esophagus and episodes of hematemesis.
Ketonuria.
Abnormal liver function test in severe cases.
Abnormal thyroid function test: Increase T4 and decrease TSH but clinically euthyroid (no thyroid antibodies).T4 levels normal by 15 weeks, TSH levels remained suppressed for a longer period.
Lack of Vitamin B1 (Thiamine) can cause Werniche's encephalopathy (40% fetal loss) with abnormal ocular movements, double vision ataxsia and/or confusion, in severe cases Werniche-Korsakoff's Syndrom psychosis (only 50% is cured).
- Is a diagnose of exclusion.
Other causes are most common: Urinary tract infection, peptic ulcer, pancreatitis and more rarely Addison's disease.
- Intravenous fluid:
Normal saline and potassium chloride is added to the infusion bags as required (no glucose infusion)
Pyridoxin-B6 10-25 mg 3 times a day Antihistamine
H1 receptor antagonists (Promethazine 25 mg 2-3 times a day). Dopamine antagonists
Phenothiazines Metoclopramid
should not be used for long period as it can cause dystonia.
Serotenin 5-HT3 antagonist: Ondansetron (Zofran) 5-hydroxytryptamin receptor antagonist 8 mg 2-3 x daily or intravenous 10 mg 3 x daily, only few studies.
Ginger 250 mg 4 times a day is more effective than placebo, but the use has recently been quistioned because of lack of evidence that Ginger is harmless in high dosis. Corticosteroid
Methylprednisolone 16 mg 3 times a day (dose reduced by half every 3rd day), if tablet is not tolerated, hydrocortisone intravenously 100 mg BID. Parenteral nutrition and/or enteral feeding.
Acupuncture -in PC6 and ST36mid seems very effective.
Prevention of Werniche's encephalopathy: Thiamine 50 mg 3 times a day. For severe cases intravenous treatment is required, Thiamine 100 mg diluted in 100 ml of normal saline and infused over 30-60 minutes.
(1) Jewell D, Young G: Interventions for nausea and vomiting in early pregnancy. Cochrane Library. Document 1998. (2) Nielson-Piercy, C. Handbook of Obstetric Medicine. 2001 Edition. (3) The management of Nausea and Vometing in Pregnancy SOGC Clinical Practice Guidelines N. 120 October 2002Top Home Table of Contents Feel free to mail me
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