Incidence: 0.1-1% of pregnancies.
Findings:
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).
Other causes are most common: Urinary tract infection, peptic ulcer, pancreatitis and more rarely Addison's disease.
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 2002
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