hyperemesis gravidarum

Question 1

what is it

Answer 1

persistent vomiting in pregnancy causing weight loss >5% pre pregnancy weight and ketosis

Question 2

when is the risk increased

Answer 2

youth, non smokers, primip, pre existing diabetes, hyperthyroid, psych, FHx, prev eating disorder, multiple/molar pregnancy

Question 3

presentation

Answer 3

inability to hold food or fluids down. weight loss +- nutritional deficiency, dehydration, hypovolaemia, tachy, postural hypo, polyneuritis, liver and renal failure, spitting

Question 4

tests

Answer 4

PCV, U&E, LFT, TFT.

Question 5

what should you exclude

Answer 5

UTI

Question 6

management

Answer 6

admit to hospital. thromboprophylaxis, thiamine supplementation, IV fluids

Question 7

what should you be aware of when rehydrating

Answer 7

too rapid reversal of hyponatraemia- central pontine myelinosis

Question 8

if doesn’t improve after rehydration what can you give

Answer 8

anti emetics- metoclopramide, cyclizine. if resistant- steroids pred