Hyperemesis Gravidarum

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%.