Hyperemesis gravidarum: Difference between revisions
(Created page with "==Background== *Simple N/V affects 60-80% of pts during first 12wk of pregnancy *Hyperemesis gravidarum defined as intractable vomiting along with: **Wt loss **Volume depletion *...") |
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==Treatment== | ==Treatment== | ||
#IVF (use fluid containing 5% glucose to reverse ketonuria) | #IVF (use fluid containing 5% glucose to reverse ketonuria) | ||
#Antiemetics | |||
##Zofran 8mg IV or 4mg PO TID | |||
##Promethazine 25-50mg IV q4hr | |||
==Disposition== | ==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== | ==Source== | ||
Revision as of 19:40, 21 August 2011
Background
- Simple N/V affects 60-80% of pts during first 12wk of pregnancy
- Hyperemesis gravidarum defined as intractable vomiting along with:
- Wt loss
- Volume depletion
- Hypokalemia
- Ketonemia
- Gestational trophoblastic disease also may present with intractable vomiting
Clinical Features
- Signs of volume depletion
- Abdominal pain is highly unusual and if present suggests a different diagnosis:
Work-Up
- CBC
- Chemistry
- UA
DDx
- 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
- Zofran 8mg IV or 4mg PO TID
- Promethazine 25-50mg IV q4hr
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