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When does N/V usually begin and end in pregnancy?
-Begins ~ 6 weeks and ends ~16 weeks
Discuss Hyperemesis Gravidarum.
- -Persistant, day & night, severe N/V
- -Possibly r/t to hormones effect on GI motility
- -familial risk
What are 4 maternal risk for untreated hyperemesis gravidarum?
- 1. Esophageal rupture
- 2. retinal hemorrhage
- 3. renal damage
- 4. spont pneumo-mediastum
What are 3 fetal risks associated with hyperemesis gravidum?
- 1. IUGR
- 2. fetal death
- 3. voluntary pregnancy termination
What are the clinical criterion for hyperemesis gravidarum?
- 1. Severe N/V unresponsive to outpatient management
- 2. Weight loss -- >5% of pre-pregnancy wt
- 3. Ketonuria (dipstick)
What 4 abnormal labs might you see?
- 1. Electrolyte imbalance (hypokal & met alkalosis)
- 2. Increased HCT (dehydration)
- 3. Slightly elevated LFTs
- 4. Mild hyperthyroidism
What labs should you obtain with eval?
What should be on your DD list for severe N/V?
- 1. Hepatitis
- 2. pancreatitis
- 3. pyelonephritis
- 4. bowel obstruction
- 5. hyperthyroidism
- 6. increased ICP
What should be give along with 2L IVF upon admission?
-1st L with 100mg thiamine, followed by 100mg QDx 3days
How much Na should be given upon admision?
- On top of the NS-->
- -give 10-12meq/L on day 1,
- -then 18meq total x 2 days
What meds may be given during hyperemesis gravidarum?
- 1. antihistamines (benadryl 1st line therapy)
- 2. Phenothiazines (phenergan)
- 3. Serotonin antagonists (zofran)
- 4. Metoclopramide
- 5. Corticosteroids (for severe, refractory)--> cleft palate risk > 10wks
- 6. Vitamin B6 (pyridoxine) + Reglan more effective than alone
What are 4 suggested meds for mild nausea?
- 1. Pyroxidine (Vit B6)
- 2. Doxuylaine (nyquil)
- 3. Phenergan
- 4. Dramamine (Dimenhydrinate)
What are meds suggested for persistent N/V with significant dehydration?
- 1. Reglan
- 2. zofran
- 3. Prochlorperazine (compazine)
- 4. Phenergan
What meds are suggested for severe hyperemesis?
- 1. Reglan
- 2. Compazine
- 3. phenergan
- 4. zofran
- 5. Medrol