Hyperemesis gravidarum

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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

  1. CBC
  2. Chemistry
  3. UA

DDx

  1. Biliary disease
  2. Ectopic pregnancy
  3. Gastroenteritis
  4. Pancreatitis
  5. Appendicitis
  6. Hepatitis
  7. Peptic ulcer disease
  8. Pyelonephritis
  9. Fatty liver of pregnancy
  10. HELLP syndrome

Treatment

  1. IVF (use fluid containing 5% glucose to reverse ketonuria)

Disposition

See Also

Source

Tintinalli

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