Hyperemesis gravidarum - Revision history

Danbot: Add MedicationDose SMW entries for pyridoxine, doxylamine, promethazine, metoclopramide, ondansetron; doses verified against ACOG guidelines

2026-03-20T17:56:39Z

Add MedicationDose SMW entries for pyridoxine, doxylamine, promethazine, metoclopramide, ondansetron; doses verified against ACOG guidelines

← Revisión anterior		Revisión del 17:56 20 mar 2026
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			==Medication Dosing==
			===1st Line (ACOG Stepwise)===
			*{{MedicationDose\|drug=Pyridoxine\|dose=10-25 mg q6-8hr\|route=PO\|context=1st line antiemetic (Vitamin B6)\|indication=Hyperemesis gravidarum\|population=Adult}}
			*{{MedicationDose\|drug=Doxylamine\|dose=12.5 mg q6-8hr\|route=PO\|context=1st line antiemetic (add to B6)\|indication=Hyperemesis gravidarum\|population=Adult}}

			===2nd Line===
			*{{MedicationDose\|drug=Promethazine\|dose=12.5-25 mg q4hr\|route=PO/PR/IV\|context=2nd line antiemetic\|indication=Hyperemesis gravidarum\|population=Adult}}
			*{{MedicationDose\|drug=Metoclopramide\|dose=5-10 mg q8hr\|route=IV\|context=2nd line antiemetic\|indication=Hyperemesis gravidarum\|population=Adult}}

			===3rd Line===
			*{{MedicationDose\|drug=Ondansetron\|dose=4-8 mg q12hr\|route=IV\|context=3rd line antiemetic\|indication=Hyperemesis gravidarum\|population=Adult\|notes=Small increased risk of oral clefts in 1st trimester}}

	==Disposition==		==Disposition==

Ostermayer: Prepared the page for translation

2026-01-04T23:09:00Z

Prepared the page for translation

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			<languages/>
			<translate>

	==Background==		==Background==
	*Simple [[nausea and vomiting]] affects 60-80% of patients during first 12wk of pregnancy
			*Simple [[Special:MyLanguage/nausea and vomiting\|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 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>		*Hyperemesis gravidarum has (rarely) been known to cause [[Special:MyLanguage/Wernicke's encephalopathy\|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==		==Clinical Features==
	[[Pregnancy]] with:
			[[Special:MyLanguage/Pregnancy\|Pregnancy]] with:
	*Nausea and vomiting		*Nausea and vomiting
	*Weight loss		*Weight loss
	*[[Hypovolemia\|Volume depletion]]		*[[Special:MyLanguage/Hypovolemia\|Volume depletion]]

			Note: [[Special:MyLanguage/Abdominal pain\|Abdominal pain]] is highly unusual and should prompt consideration of a different diagnosis''

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

	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{NV in pregnancy DDX}}		{{NV in pregnancy DDX}}
			<translate>


	==Evaluation==		==Evaluation==


	===Workup===		===Workup===
	*[[Urinalysis]] for ketones
			*[[Special:MyLanguage/Urinalysis\|Urinalysis]] for ketones
	*Chemistry		*Chemistry
	**May show signs of [[dehydration]], [[hypokalemia]]		**May show signs of [[Special:MyLanguage/dehydration\|dehydration]], [[Special:MyLanguage/hypokalemia\|hypokalemia]]
	*CBC		*CBC


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

			''Note: [[Special:MyLanguage/Abdominal pain\|Abdominal pain]] is highly unusual and should prompt consideration of a different diagnosis''

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

	==Management==		==Management==


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


	===Antiemetics===		===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		''ACOG recommends a stepwise approach to [[Special:MyLanguage/nausea and vomiting\|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>''
	*ADD [[Doxylamine]] 12.5mg q6-8hrs		*[[Special:MyLanguage/Vitamin B6\|Vitamin B6]] 10-25mg q6-8hrs
	*ADD [[Promethazine]] 12.5-25mg q4hrs PO or PR		*ADD [[Special:MyLanguage/Doxylamine\|Doxylamine]] 12.5mg q6-8hrs
	*ADD [[Dimenhydrinate]] 50mg q4-6hrs IV '''OR''' [[metoclopramide]] 5-10mg q8hrs IV '''OR''' [[promethazine]] 12.5-25mg q4hrs IV		*ADD [[Special:MyLanguage/Promethazine\|Promethazine]] 12.5-25mg q4hrs PO or PR
	*ADD [[Methylprednisolone]] 16mg q8hrs PO or IV for 3 days and taper to effective dose '''OR''' [[ondansteron]] 8mg (or 4mg) q12hrs IV		*ADD [[Special:MyLanguage/Dimenhydrinate\|Dimenhydrinate]] 50mg q4-6hrs IV '''OR''' [[Special:MyLanguage/metoclopramide\|metoclopramide]] 5-10mg q8hrs IV '''OR''' [[Special:MyLanguage/promethazine\|promethazine]] 12.5-25mg q4hrs IV
	**If using [[ondansetron]], reasonable to have a discussion about claimed risks of birth defects.		*ADD [[Special:MyLanguage/Methylprednisolone\|Methylprednisolone]] 16mg q8hrs PO or IV for 3 days and taper to effective dose '''OR''' [[Special:MyLanguage/ondansteron\|ondansteron]] 8mg (or 4mg) q12hrs IV
	**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>		**If using [[Special:MyLanguage/ondansetron\|ondansetron]], reasonable to have a discussion about claimed risks of birth defects.
			**First-trimester exposure to [[Special:MyLanguage/ondansetron\|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"		{\| class="wikitable"
	\| align="center" style="background:#f0f0f0;"\|'''Medication'''		\| align="center" style="background:#f0f0f0;"\|'''Medication'''
	\| align="center" style="background:#f0f0f0;"\|'''[[Drug ratings in pregnancy\|Pregnancy Drug Class]]'''		\| align="center" style="background:#f0f0f0;"\|'''[[Special:MyLanguage/Drug ratings in pregnancy\|Pregnancy Drug Class]]'''
	\|-		\|-
	\| [[Vitamin B6]]\|\|A		\| [[Special:MyLanguage/Vitamin B6\|Vitamin B6]]\|\|A
	\|-		\|-
	\| [[Dimenhydrinate]]\|\|B		\| [[Special:MyLanguage/Dimenhydrinate\|Dimenhydrinate]]\|\|B
	\|-		\|-
	\| [[Doxylamine]]\|\|A		\| [[Special:MyLanguage/Doxylamine\|Doxylamine]]\|\|A
	\|-		\|-
	\| [[Ondansetron]]\|\|B		\| [[Special:MyLanguage/Ondansetron\|Ondansetron]]\|\|B
	\|-		\|-
	\| [[Metoclopramide]]\|\|B		\| [[Special:MyLanguage/Metoclopramide\|Metoclopramide]]\|\|B
	\|-		\|-
	\| [[Promethazine]]\|\|C		\| [[Special:MyLanguage/Promethazine\|Promethazine]]\|\|C
	\|}		\|}


	==Disposition==		==Disposition==

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


	==See Also==		==See Also==
	*[[Nausea and vomiting]]
			*[[Special:MyLanguage/Nausea and vomiting\|Nausea and vomiting]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:OBGYN]]		[[Category:OBGYN]]
	[[Category:GI]]		[[Category:GI]]
			</translate>

Rossdonaldson1 at 03:20, 8 January 2022

2022-01-08T03:20:13Z

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	==Clinical Features==		==Clinical Features==
	*Defined as intractable [[~~vomiting~~]] with ~~at least 1 of following~~:		[[Pregnancy]] with:
	**Weight loss		*Nausea and vomiting
	**[[Hypovolemia\|Volume depletion]]		*Weight loss
	**[[Hypokalemia]]		*[[Hypovolemia\|Volume depletion]]
	**[[Ketonemia]]

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

	==Differential Diagnosis==		==Differential Diagnosis==
Línea 24:		Línea 23:

	==Diagnosis==		==Diagnosis==
	*~~See clinical features~~		*Defined as intractable [[vomiting]] with at least 1 of following:
	**~~Typically~~ a ~~clinical~~ diagnosis ~~with additional evaluation of ketones~~		**Weight loss
			**[[Hypovolemia\|Volume depletion]]
			**[[Hypokalemia]]
			**[[Ketonemia]]

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

	==Management==		==Management==

Rossdonaldson1: /* Diagnosis */

2022-01-08T03:18:51Z

Diagnosis

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	==Diagnosis==		==Diagnosis==
	*		*See clinical features
			**Typically a clinical diagnosis with additional evaluation of ketones

	==Management==		==Management==

Rossdonaldson1: /* Disposition */

2022-01-08T03:15:37Z

Disposition

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	**Persistent [[ketonemia]] or [[electrolyte abnormalities]] after [[volume repletion]]		**Persistent [[ketonemia]] or [[electrolyte abnormalities]] after [[volume repletion]]
	**Weight loss >10% of pre-pregnancy weight		**Weight loss >10% of pre-pregnancy weight

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

			==External Links==

	==References==		==References==

Rossdonaldson1: /* Differential Diagnosis */

2021-11-25T13:43:06Z

Differential Diagnosis

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

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Differential Diagnosis */

2021-11-25T13:42:39Z

Differential Diagnosis

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

	==Evaluation==		==Evaluation==

Rossdonaldson1: /* Evaluation */

2021-06-12T22:24:46Z

Evaluation

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	**May show signs of [[dehydration]], [[hypokalemia]]		**May show signs of [[dehydration]], [[hypokalemia]]
	*CBC		*CBC

			==Diagnosis==
			*

	==Management==		==Management==

Rossdonaldson1: /* Disposition */

2021-06-12T22:18:52Z

Disposition

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	==Disposition==		==Disposition==
	*Discharge if able to tolerate ~~PO and ketonuria resolved~~		*Discharge if clear diagnosis and able to tolerate POs
	*Admit		*Admit
	**Uncertain diagnosis		**Uncertain diagnosis

Sebenatar: /* Antiemetics */

2021-01-12T21:53:41Z

Antiemetics

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	\| [[Doxylamine]]\|\|A		\| [[Doxylamine]]\|\|A
	\|-		\|-
	\| [[Ondansetron]]\|\|C		\| [[Ondansetron]]\|\|B
	\|-		\|-
	\| [[Metoclopramide]]\|\|B		\| [[Metoclopramide]]\|\|B