Hyperemesis gravidarum: Difference between revisions
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==Background== | ==Background== | ||
*Simple N/V affects 60-80% of pts during first 12wk of pregnancy | *Simple N/V affects 60-80% of pts during first 12wk of pregnancy | ||
*Hyperemesis gravidarum defined as intractable vomiting | *Hyperemesis gravidarum defined as intractable vomiting with at least 1 of following: | ||
**Wt loss | **Wt loss | ||
**Volume depletion | **Volume depletion | ||
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**Ketonemia | **Ketonemia | ||
*Gestational trophoblastic disease also may present with intractable vomiting | *Gestational trophoblastic disease also may present with intractable vomiting | ||
*Thryotoxicosis also may present with intractable vomiting | |||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 00:19, 24 August 2011
Background
- Simple N/V affects 60-80% of pts during first 12wk of pregnancy
- Hyperemesis gravidarum defined as intractable vomiting with at least 1 of following:
- Wt loss
- Volume depletion
- Hypokalemia
- Ketonemia
- Gestational trophoblastic disease also may present with intractable vomiting
- Thryotoxicosis 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