HYPEREMESIS GRAVIDARUM

Question 1

Definition for HG

Answer 1

Excessive vomiting usually during the first trimester

Question 2

Differential diagnosis of HG (medical)

Answer 2

Malaria
UTI
Gastritis
Peptic ulcer disease
Hepatitis
Hypoglycemia

Question 3

Differential diagnosis of HP (Surgical)

Answer 3

Bowel obstruction
Acute appendicitis
Cholecystitis
Twisted ovarian cyst

Question 4

Risk factors or associations of HG

Answer 4

Multiple pregnancy
Molar pregnancy

Question 5

Cause of HG

Answer 5

Pregnancy

Question 6

Symptoms of HG

Answer 6

Excessive vomiting
Inability to eat or drink
Weight loss

Question 7

Signs of HG

Answer 7

Looks unwell
Dehydration
Rapid and thready pulse
Hypotension
HYperventilation

Question 8

What is a thready pulse

Answer 8

A thready pulse or weak pulse is one that is difficult to feel or obliterated easily with slight pressure.

Question 9

Hyperventilation

Answer 9

Deep and fast breathing

Question 10

Investigations in HG

Answer 10

FBC
Blood film for malaria parasites
Urinalysis and culture
Blood urea and electrolytes
Abdominopelvic ultrasound

Question 11

Treatment objectives of HG

Answer 11

To stop the vomiting
To rehydrate the patient
To treat shock if present
To treat associated conditions e.g. UTI, malaria etc.

Question 12

Non-pharmacological management of HG

Answer 12

Mild cases can have treatment at home with frequent small meals
Dry foods such as biscuits may be very helpful
Drink fluids in sips or small volumes, if able to

Question 13

Drugs used for pharmacological management for mild cases of HG

Answer 13

1st line- Metoclopramide

2nd line- Promethazine theoclate or HCl

Question 14

Dose for metoclopramide in mild cases of HG

Answer 14

10mg PO 8-12 hourly

Question 15

Dose for promethazine in mild cases of HG

Answer 15

25mg PO 8-12 hourly

Question 16

Fluids used for rehydration in severe HG

Answer 16

Normal saline/Dextrose 5% Water

Ringers lactate/Dextrose 5% Water

Question 17

Drugs for management of severe HG

Answer 17

1st line - Metoclopramide

2nd line - Ondansetron

3rd line - Promethazine HCl

Question 18

Dose for promethazine HCl in severe cases of HG

Answer 18

IM or IV 25mg 8-12 hourly, max. dose 100mg

Question 19

Dose for metoclopramide in severe cases of HG

Answer 19

IV, IM
<60kg: 5mg 8 hourly

> 60kg: 5-10mg 8 hourly

Max. of 500mcg\kg in a day

Question 20

Dose for ondansetron in severe cases of HG

Answer 20

PO, IV, IM
4-8mg 8 hourly as needed

Question 21

Referral criteria for HG

Answer 21

Severe cases with dehydration and or shock and metabolic disturbances to a hospital for IV fluids and antiemetics