Ver el código de «Hyperemesis gravidarum»

==Background==
*Simple [[nausea and vomiting]] affects 60-80% of patients during first 12wk of pregnancy
*Hyperemesis gravidarum only affects 0.3-2% of pregnancies<ref>Goodwin, TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am. 2008 Sep;35(3):401-17</ref>
*Hyperemesis gravidarum has (rarely) been known to cause [[Wernicke's encephalopathy]]<ref>Kantor S, Prakash S, Chandwani J, Gokhale A, Sarma K, Albahrani MJ. Wernicke's encephalopathy following hyperemesis gravidarum. Indian J Crit Care Med. 2014;18(3):164–166. doi:10.4103/0972-5229.128706</ref><ref>Kotha VK, De Souza A. Wernicke's encephalopathy following Hyperemesis gravidarum. A report of three cases. Neuroradiol J. 2013;26(1):35–40. doi:10.1177/197140091302600106</ref>

==Clinical Features==
[[Pregnancy]] with:
*Nausea and vomiting
*Weight loss
*[[Hypovolemia|Volume depletion]]

Note: [[Abdominal pain]] is highly unusual and should prompt consideration of a different diagnosis''

==Differential Diagnosis==
{{NV in pregnancy DDX}}

==Evaluation==
===Workup===
*[[Urinalysis]] for ketones
*Chemistry
**May show signs of [[dehydration]], [[hypokalemia]]
*CBC

==Diagnosis==
*Defined as intractable [[vomiting]] with at least 1 of following:
**Weight loss
**[[Hypovolemia|Volume depletion]]
**[[Hypokalemia]]
**[[Ketonemia]]

''Note: [[Abdominal pain]] is highly unusual and should prompt consideration of a different diagnosis''

==Management==
===Rehydration===
*[[oral rehydration therapy|PO fluids]] if able to tolerate
*[[IVF|IV fluid repletion]] (use D5NS in the setting of ketonuria)

===Antiemetics===
''ACOG recommends a stepwise approach to [[nausea and vomiting]] in pregnancy<ref>Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 153. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2015; 126(3):e12-24</ref>''
*[[Vitamin B6]] 10-25mg q6-8hrs
*ADD [[Doxylamine]] 12.5mg q6-8hrs
*ADD [[Promethazine]] 12.5-25mg q4hrs PO or PR
*ADD [[Dimenhydrinate]] 50mg q4-6hrs IV '''OR''' [[metoclopramide]] 5-10mg q8hrs IV '''OR''' [[promethazine]] 12.5-25mg q4hrs IV
*ADD [[Methylprednisolone]] 16mg q8hrs PO or IV for 3 days and taper to effective dose '''OR''' [[ondansteron]] 8mg (or 4mg) q12hrs IV
**If using [[ondansetron]], reasonable to have a discussion about claimed risks of birth defects.
**First-trimester exposure to [[ondansetron]] was not associated with cardiac or congenital malformations but was associated with a small increased risk of oral clefts.<ref>Fejzo MS, et al. Ondansetron in pregnancy and risk of adverse fetal outcomes in the United States. Reprod Toxicol. 2016 Jul;62:87-91.</ref>

{| class="wikitable" 
| align="center" style="background:#f0f0f0;"|'''Medication'''
| align="center" style="background:#f0f0f0;"|'''[[Drug ratings in pregnancy|Pregnancy Drug Class]]'''
|-
| [[Vitamin B6]]||A
|-
| [[Dimenhydrinate]]||B
|-
| [[Doxylamine]]||A
|-
| [[Ondansetron]]||B
|-
| [[Metoclopramide]]||B
|-
| [[Promethazine]]||C
|}

==Disposition==
*Discharge if clear diagnosis and able to tolerate POs
*Admit
**Uncertain diagnosis
**Intractable [[vomiting]]
**Persistent [[ketonemia]] or [[electrolyte abnormalities]] after [[volume repletion]]
**Weight loss >10% of pre-pregnancy weight

==See Also==
*[[Nausea and vomiting]]

==External Links==

==References==
<references/>

[[Category:OBGYN]]
[[Category:GI]]