Hyperemesis Gravidarum

Question 1

when does HG usually start

Answer 1

between week 4 and 7

tends to go away by 2nd trimester = a 1st trimester problem

Question 2

what ar the 3 parts of the diagnostic criteria for HG

Answer 2

5% weight loss, dehydration adn electrolyte imbalance

Question 3

pathophysiology

Answer 3

not fully known but is thouht to be related to bhCG

Question 4

investigations - name 4

Answer 4

• urine
• weight
• bloods
• US to check for multiple/molar

Question 5

what modifications can be done to diet

Answer 5

small and more freuqent meals

bland food is often easier to keep down

Question 6

3 parts of management

Answer 6

rehydration with IV fluids

anti emetics

thromboprophylaxis

Question 7

what are the 1st and 2n line anti-emetics

Answer 7

1st line anti-histamines: cyclizine and prochloperazine

2nd line ondansetron and metoclopramide

Question 8

why is there a need for thromboprophylaxis

Answer 8

both dehydration and pregnancy are independent risk factors

Question 9

how does th emanagement differ if patient is B1 deficient

Answer 9

thiamine (B1) is required for glucose metabolism, B1 must be given before fluids or food

otherwise remaining B1 will be used up and will get Wernicke encephalopathy?

Question 10

what happens in refeeding syndrome

Answer 10

• starvation results in depletion of body electrolytes
• to maintain serum concentrations the IC stores are moved out into the serum
• when refeed - insulin drives the electrlytes back into cells
• –> very low serum concentrations
• –> confusion, seizure, arrhythmia, coma, death