toxicosis

Question 1

hyperemesis gravidarum - where ar eyou most likely to see

Answer 1

hyperemesis gravidarum

is due to ↑hCG hence common in molar/multiple pregnancies.

Question 2

ptyalismus

Answer 2

Excessive salivation + inability to swallow saliva
 Hyper salivation: Loss up to 1-1.5L liquid leading to decrease of blood volume,
dysproteinaemia and skin maceration (skin looks wrinkly and lighter)
 Treatment: belladonna & atropine - limited in dose so there’s short-term relief only
of the condition

Question 3

tx for hyperemesis

Answer 3

IV crystalloid solutions (physiological solution, Ringer, glucose 5%-10% with 1 unit of
insulin per 4g of glucose) 1-2.5L under control of diuresis (50-60ml/hr) which help
prevent kidney failure – N.B rapid correction= central pontine myelinolysis
 Albumins and amino acids in case of hypoproteinaemia
 Hepatoprotectors
 Vitamin B1 (Thiamine, B9 and B12), C
 Thromboprophylaxis: LMWH + TED stockings
 No improvement: Antiemetic’s 1st= Promethazine or Cyclozine. 2nd line= ProkineticMetoclopramide, prochlorperazine, chlorpromazine or domperidone. If still resistant
then steroids may help - Hydrocortisone, prednisolone.have a direct effect on vomitting centre
 Diet: Small frequent meals -high carb and low fat. high protein Ginger can help
 N.B don’t admit 2 wom

Question 4

complications of hyperemesis gravidarum

Answer 4

dehydration, loss of weigh , electrolyte imbalnced (morst common) thiamine defieicney (b1) - wernikes encephalopathy

rare-
clots
liver damage 
Esophageal damage from forceful vomiting
Wernicke encephalopathy is caused by a vitamin B1 deficiency, which can be caused by hyperemesis gravidarum. Symptoms include vision changes, loss of muscle coordination, confusion, and loss of mental activity resulting in coma.

Question 5

indications for pregnancy termination in severe vomititng

Answer 5

Signs of hepatic failure (jaundice, elevated liver enzymes)
 Signs of renal insufficiency (oliguria, anuria)
 Encephalopathy
 Absence of effect of treatment (continuing weight loss, multiple vomiting)

Question 6

risk factors for hyperemssi gravidaerum

Answer 6

hyperthryoidsism

Question 7

rare forms of gestosis

Answer 7

Pregnancy dermatosis
 Gravidarum tetania
 Gravidarum osteomalacia
 Gravidarum bronchial asth

Question 8

RF hyperemesis gravidarum

Answer 8

young 
non smoker 
primigravida 
hyperthyroidsim 
multiple pregnaancies

Question 9

example of early and late toxicosis

Answer 9

<20 weeks
nausea
vomitting

late >20
- preclampsia
eclampsia

Question 10

labs of hyperemesis to llok for

Answer 10

metabolic acidosis due to ketone

electrolyte imbalances

Question 11

how to define hyperemesis clincally

Answer 11

> 5% body weight
vomiting 20-25 x a day
typically Typical symptom = ptyalism (excessive saliva production)

Question 12

clincial picture

Answer 12

Vomiting throughout the day and night

· Ptyalism

· Dizziness

· Sleep disturbances

· Hyper-olfaction (increased sense of smell)

· Dysgeusia (a taste disorder where all foods taste sour, sweet, bitter or metallic)

· Psychological disturbances – depression, anxiety, irritability, mood changes, decreased concentration

· Dehydration, weight loss, sunken eyes, dry mouth, hypotension

· Mild fever

Question 13

diagnis s

Answer 13

Is only diagnosed when the onset is in the first trimester of pregnancy and other causes of nausea and vomiting have been excluded

· History

· The triad of symptoms to diagnose HG =

a. >5% body weight loss
b. Dehydration
c. Electrolyte imbalance

make sure to exclude trophoblastic disease and multiple preganncy