Diferencia entre revisiones de «Hyperemesis gravidarum»
Sin resumen de edición |
Sin resumen de edición |
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| Línea 10: | Línea 10: | ||
*Signs of volume depletion | *Signs of volume depletion | ||
*[[Abdominal pain]] is highly unusual and if present suggests a different diagnosis | *[[Abdominal pain]] is highly unusual and if present suggests a different diagnosis | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Línea 29: | Línea 24: | ||
*Fatty liver of pregnancy | *Fatty liver of pregnancy | ||
*[[HELLP syndrome]] | *[[HELLP syndrome]] | ||
==Diagnosis== | |||
*H&P | |||
*CBC | |||
*Chemistry | |||
*UA | |||
==Management== | ==Management== | ||
===Antiemetics=== | |||
*ACOG recommends a stepwise approach to N/V in pregnancy<ref>Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 52. American Collegfe of Obstetricians and Gynecologists. Obstet Gynecol. 2004; 103:803-815</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 Ondansetron 8mg (or 4mg) q12hrs IV | |||
***If using ondansetron, have a discussion about claimed risks of birth defects, and document this due to arising class action lawsuits | ***If using ondansetron, have a discussion about claimed risks of birth defects, and document this due to arising class action lawsuits | ||
***Ondansetron is still class B (no proven risk to humans) | ***Ondansetron is still class B (no proven risk to humans) | ||
===Rehydration=== | |||
* | *IVF | ||
* | *Consider fluid with D5 in the setting of ketonuria | ||
==Disposition== | ==Disposition== | ||
Revisión del 12:15 19 jun 2015
Background
- Simple nausea and vomiting 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
Clinical Features
- Signs of volume depletion
- Abdominal pain is highly unusual and if present suggests a different diagnosis
Differential Diagnosis
- Gestational trophoblastic disease (may present with intractable vomiting)
- Thyrotoxicosis (may present with intractable vomiting)
- Biliary disease
- Ectopic pregnancy
- Gastroenteritis
- Pancreatitis
- Appendicitis
- Hepatitis
- Peptic ulcer disease
- Pyelonephritis
- Fatty liver of pregnancy
- HELLP syndrome
Diagnosis
- H&P
- CBC
- Chemistry
- UA
Management
Antiemetics
- ACOG recommends a stepwise approach to N/V in pregnancy[1]
- 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 Ondansetron 8mg (or 4mg) q12hrs IV
- If using ondansetron, have a discussion about claimed risks of birth defects, and document this due to arising class action lawsuits
- Ondansetron is still class B (no proven risk to humans)
Rehydration
- IVF
- Consider fluid with D5 in the setting of ketonuria
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
References
- ↑ Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 52. American Collegfe of Obstetricians and Gynecologists. Obstet Gynecol. 2004; 103:803-815