Hyperemesis gravidarum

Nausea and vomiting of pregnancy

  • N/V (uncomplicated) starting at ~5wks, worse at ~9wks, usually resolves by 20wks

  • Be concerned about hydatidiform mole

  • Normal VS without ssx of dehydration

Hyperemesis gravidarum

  • Severe, persistent N/V ➔ weight loss and hypovolemia

    • Dehydration ➔ ketonuria, hypersalivation, orthostatic hypotension, malnourishment

    • HypoK, hypoCl, metabolic alkalosis, ↑ hematocrit

  • N/V TX in pregnancy

    • Oral hydration, ginger, diet changes

      • If refractory to diet changes ➔ antiemetics: Pyridoxine (vitamin B6) or doxylamine

    • Add one of following if refractory:

      • Diphenhydramine, dimenhydrinate, prochlorperazine, promethazine

    • Add one of following if refractory despite combo

      • Metoclopramide, ondansetron

    • Last resort: Add chlorpromazine or methylprednisolone

  • Severe: IVF, thiamine (to prevent Wernicke encephalopathy) and electrolyte repletion

    • Enteral feeding/TPN if continued weight loss despite abov