NAUSEA, VOMITING AND HYPEREMESIS IN PREGNANCY

Question 1

Approach to the Critical Patient with Severe Vomiting in Pregnancy

Answer 1

Treat hypotension and shock with fluids and vasopressors as needed

thiamine 100 mg IV prior to dextrose to prevent Wernicke’s encephalopathy

Metoclopramide 10 mg IV/IM

Ondansetron 4 mg IV/IM or oral disintegrating tablet

If refractory:

Promethazine 12.5-25 mg IM

Question 2

Clinical Features

Answer 2

persistent vomiting
weight loss
dehydration
Should be before 9-12 wks GA

Question 3

Management: Stable

Answer 3

0.9% sodium chloride or 5% dextrose in 0.9% normal saline.

thiamine 100 mg IV

Diphenhydramine 25-50 mg IV/IM or PO

Metoclopramide 10 mg IV/IM or PO

Ondansetron 4 mg IV/IM or oral disintegrating tablet

Pyridoxine 10-25 mg orally (PO)

Question 4

Disposition: Home

Answer 4

pyridoxine 10-25 mg PO q8h

or

extended-release pyridoxine 10 mg with doxylamine 10 mg PO

Max 4 doses/day.

If above do not work, trial another anti emetic

Question 5

Disposition: Admission

Answer 5

Methylprednisolone 16 mg IV q 8 hr