HYPEREMESIS GRAVIDARUM Flashcards

1
Q

Definition for HG

A

Excessive vomiting usually during the first trimester

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2
Q

Differential diagnosis of HG (medical)

A

Malaria
UTI
Gastritis
Peptic ulcer disease
Hepatitis
Hypoglycemia

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3
Q

Differential diagnosis of HP (Surgical)

A

Bowel obstruction
Acute appendicitis
Cholecystitis
Twisted ovarian cyst

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4
Q

Risk factors or associations of HG

A

Multiple pregnancy
Molar pregnancy

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5
Q

Cause of HG

A

Pregnancy

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6
Q

Symptoms of HG

A

Excessive vomiting
Inability to eat or drink
Weight loss

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7
Q

Signs of HG

A

Looks unwell
Dehydration
Rapid and thready pulse
Hypotension
HYperventilation

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8
Q

What is a thready pulse

A

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

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9
Q

Hyperventilation

A

Deep and fast breathing

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10
Q

Investigations in HG

A

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

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11
Q

Treatment objectives of HG

A

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

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12
Q

Non-pharmacological management of HG

A

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

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13
Q

Drugs used for pharmacological management for mild cases of HG

A

1st line- Metoclopramide

2nd line- Promethazine theoclate or HCl

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14
Q

Dose for metoclopramide in mild cases of HG

A

10mg PO 8-12 hourly

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15
Q

Dose for promethazine in mild cases of HG

A

25mg PO 8-12 hourly

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16
Q

Fluids used for rehydration in severe HG

A

Normal saline/Dextrose 5% Water

Ringers lactate/Dextrose 5% Water

17
Q

Drugs for management of severe HG

A

1st line - Metoclopramide

2nd line - Ondansetron

3rd line - Promethazine HCl

18
Q

Dose for promethazine HCl in severe cases of HG

A

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

19
Q

Dose for metoclopramide in severe cases of HG

A

IV, IM
<60kg: 5mg 8 hourly

> 60kg: 5-10mg 8 hourly

Max. of 500mcg\kg in a day

20
Q

Dose for ondansetron in severe cases of HG

A

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

21
Q

Referral criteria for HG

A

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