| General Illness Information |
Common Name: |
Morning
Sickness (Severe) |
|
Medical Term:
|
Hyperemesis gravidarum |
| Description: |
|
Persistent severe nausea
and vomiting in a pregnancy.
|
|
This may lead to
dehydration and drastic changes in body chemistry.
|
|
This is different from,
and much more serious than, morning sickness during
pregnancy.
|
|
| Causes: |
Unknown
May be psychological factors
Hyperthyroidism
Hyperparathyroidism
Gestational hormones
Liver dysfunction
Autonomic nervous system dysfunction
|
| Prevention: |
|
Don't use any drugs,
including non-prescription drugs or alcohol, during
pregnancy without medical advice.
|
|
Maintain an adequate
diet during all stages of pregnancy.
|
|
| Signs
& Symptoms |
|
Hypersensitivity to smell
Alteration in taste
Nausea
Vomiting with retching
Acidosis
Decreased urine output
Volume depletion
Fatigue
Starvation
|
|
| Risk Factors |
|
Altered gastrointestinal
function
Various odors
Taste or sight of food
Hyperthyroidism
Hyperparathyroidism
Obesity
Multiple pregnancies
Nulliparity
Liver dysfunction
|
| Diagnosis & Treatment |
|
Electrolytes decreased
Urinalysis - glycosuria, albuminuria,
granular casts and hematuria
Increased uric acid
Reduced protein in blood
There is no specific test for the
diagnosis of Hyperemesis.
|
| General
Measures: |
|
Patient reassurance
Bed rest
If dehydrated, IV fluids.
Repeat if there is a recurrence of
symptoms following initial improvement.
|
|
| Medications: |
|
Pyridoxine 10-30 mg daily IV. Not always
effective, but not harmful.
Antihistamines (e.g., diphenhydramine
or dimenhydrinate, or doxylamine)
Phenothiazines (e.g., promethazine or
prochlorperazine)
Meclizine
Methylprednisolone
|
|
| Activity: |
|
As tolerated, if ambulant.
|
|
| Diet: |
|
Nothing by mouth for first 24
hours if patient is ill enough to require hospitalization
· For
outpatient: A diet rich in carbohydrates and protein, such
as fruit, cheese, cottage cheese, eggs, beef, poultry,
vegetables, toast, crackers, rice. Limit intake of
butter.
Patients should avoid spicy meals and high
fat foods.
|
|
| Possible
Complications : |
|
Patients with greater than a 5%
weight loss are associated with intrauterine growth
retardation and fetal anomalies
Hemorrhagic retinitis
Liver damage
Central nervous system deterioration,
sometimes leading to coma
|
|
| Prognosis |
|
Self-limited illness with good
prognosis if patient's weight is maintained at greater than 95% of
the pre-pregnancy weight
With complication of hemorrhagic
retinitis, mortality rate is 50%
|