Back to Basics: Hyperemesis Gravidarum
Intractable vomiting of pregnancy with:
- Weight loss > 5%
- Volume depletion
Work-up and Management:
- UA, Upreg → for ketonuria
- Chem7, Mg → for hypochloremic, hypokalemic metabolic alkalosis
- Lifestyle modifications → avoid triggers + small meals + ginger ale
- B6 + Doxylamine aka Diclegis
- D5NS with low threshold to add thiamine to avoid Wernicke’s
- Promethazine v. Reglan v. Zofran if refractory
Risk Management Strategies/ Pitfalls:
- Hyperemesis gravidarum and morning sickness should be a diagnosis of exclusion in the pregnant vomiting patient.
- Abdominal pain is highly unusual and should prompt a broad differential. Don’t forget about surgical etiologies like appendicitis and ovarian torsion
- Broaden the differential diagnosis when there is increase in vomiting at 9+ weeks
Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008;35(3):401–417 [PubMed: 18760227].