Hyperemesis Gravidarum

by Veronica Gillispie, MD, FACOG

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    So now let's discuss Hyperemesis Gravidarum. Let's start with a case. A 25 year old Gravida 1 Para 0 female at 8 weeks gestation presents to the emergency room with complaint of nausea vomiting. She says she is unable to keep anything down. She reports a 10 pound weight loss throughout the pregnancy. On physical exam she appears dehydrated. Vital signs are stable and she is afebrile. Her basic metabolism panel shows a potassium of 2.9 and a sodium of 131. What is her diagnosis? Let's explore the lecture to find out. So hyperemesis gravidarum, what are the signs and symptoms? First, intractable nausea and vomiting. Now it's very common in pregnancy to have nausea and vomiting in the 1st trimester. And this usually resolves by 13 weeks. However, with hyperemesis gravidarum this is intractable and it usually can continue into the 2nd trimester. Patients with hyperemesis gravidarum usually have weight loss that can be anywhere from 5 to 10 pounds all the way up to 15 to 20 pounds. They also experience electrolyte disturbance. This is usually manifest in a low potassium. Sometimes low sodium as well. And they can have a metabolic acidosis. So how we treat hyperemesis gravidarum. Well the first thing we want to do is IV hydration. Now it's very important that this hydration be first with normal saline. Why is that? Well, pregnancy is a state that can make you thyamine deficient. If you begin to hydrate with something that contains D-5 or some type of a glucose solution, that can worsen the thyamine deficiency. And actually lead to something called Wernicke's Encephalopathy. The other thing about hydration is you need to make sure it is slow. If you hydrate too quickly, you can cause central pontine myelinolysis. We want to avoid that. So...

    About the Lecture

    The lecture Hyperemesis Gravidarum by Veronica Gillispie, MD, FACOG is from the course Postpartum Care. It contains the following chapters:

    • Hyperemesis Gravidarum
    • Hyperemesis Gravidarum – Treatment

    Included Quiz Questions

    1. Slow infusion of normal saline
    2. Rapid bolus infusion of normal saline
    3. Rehydration with oral dextrose solution
    4. Slow infusion of lactated ringers in 5% dextrose solution
    5. Bolus of lactated ringers in 5% dextrose solution
    1. Vitamin B6 and doxylamine
    2. Odansetron (Zofran)
    3. Metoclopramide
    4. Phenergan
    5. Midazolam
    1. Thiamine (vitamin B1) deficiency
    2. Potassium deficiency
    3. Sodium deficiency
    4. Pyridoxine (vitamin B6) deficiency
    5. Folate (vitamin B9) deficiency

    Author of lecture Hyperemesis Gravidarum

     Veronica Gillispie, MD, FACOG

    Veronica Gillispie, MD, FACOG

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    She is really amazing
    By Eduarth R. on 08. February 2017 for Hyperemesis Gravidarum

    She is really amazing! I have been learning a lot. Thanks Dra. Veronica Gillispie.