Definition intractable nausea and vomiting to extent of weight loss, dehydration and electrolyte imbalance, acid-base disturbance and i...
Definition
- intractable nausea and vomiting to extent of weight loss, dehydration and electrolyte imbalance, acid-base disturbance and if severe, hepatic and renal damage
- usually present in T1 then diminishes or persists throughout pregnancy
in a minority
Etiology
- presently thought to be multifactorial with hormonal, immunologic and psychologic components
- high or rapidly rising beta-hCG or estrogen levels are implicated
- Mallory Weiss tears
- Wernicke's encephalopathy, if protracted course
- death
Fetal Complications
- usually none
- IUGR is 15x more common in women losing > 5% of prepregnant weight
Differential Diagnosis of Nausea and Vomiting
- hyperemesis is a diagnosis of exclusion
- GI inflammation/infection
- appendicitis
- cholecystitis
- hepatitis
- gastroenteritis
- pancreatitis
- PUD
- fatty liver of pregnancy
- pyelonephritis
- thyrotoxicosis
- multiple gestation
- GTN
- HELLP syndrome
- labs (CBC, lytes, BUN and creatinine, urinalysis, LFTs)
- ultrasound (to R/O molar pregnancy, multiple pregnancy and to assess liver, pancreas, gallbladder, etc...)
Treatment
General
- early recognition is important
- if severe, admit to hospital
- NPO initially, then small frequent meals of appealing foods
- correct hypovolemia, electrolyte imbalance and ketosis
- thiamine, if indicated
- TPN if severe to reverse catabolic state
- consider emotional support, dietary and psychologic counselling
Pharmacological options
- dimenhydrinate (Gravol)
- vitamin B6 and doxylamine succinate (Diclectin)
Non-pharmacological options
- accupressure at inner aspect of the wrists, just proximal to the flexor crease has been shown to significantly reduce symptoms of nausea and vomiting
- avoid triggers (i.e. certain smells)
