Hyperemesis Gravidarum

Hyperemesis gravidarum is a persistent vomiting during pregnancy, leading to dehydration, weight loss and ketosis. The diagnosis results from the clinical findings and the determination of ketone bodies in urine, serum electrolytes and renal function. The treatment is carried out by temporary abandonment of oral feeding and intravenous hydration, anti-emetics, and if necessary vitamins and electrolyte substitution.

It often happens that pregnancy nausea and vomiting caused. Was due to the rapidly rising serum levels of the estrogen or of the ?-subunit of human chorionic gonadotropin (?-hCG) seem to be. The vomiting usually develops around the fifth week of pregnancy has the 9th SSW the climax and disappears after about the 16th or 18th week of pregnancy. It usually occurs in the morning (as so-called morning sickness), but can occur at any time of day. Women serving a daily vomiting continue to increase in importance and will not be dehydrated. Hyperemesis gravidarum is probably an extreme form of normal nausea and vomiting during pregnancy. It can be defined by the following reasons:

Hyperemesis gravidarum is a persistent vomiting during pregnancy, leading to dehydration, weight loss and ketosis. The diagnosis results from the clinical findings and the determination of ketone bodies in urine, serum electrolytes and renal function. The treatment is carried out by temporary abandonment of oral feeding and intravenous hydration, anti-emetics, and if necessary vitamins and electrolyte substitution. It often happens that pregnancy nausea and vomiting caused. Was due to the rapidly rising serum levels of the estrogen or of the ?-subunit of human chorionic gonadotropin (?-hCG) seem to be. The vomiting usually develops around the fifth week of pregnancy has the 9th SSW the climax and disappears after about the 16th or 18th week of pregnancy. It usually occurs in the morning (as so-called morning sickness), but can occur at any time of day. Women serving a daily vomiting continue to increase in importance and will not be dehydrated. Hyperemesis gravidarum is probably an extreme form of normal nausea and vomiting during pregnancy. It can be defined by the following reasons: weight loss (> 5% of body weight) dehydration ketoacidosis electrolyte abnormalities (many women) hyperemesis gravidarum can cause mild, transient hyperthyroidism. Hyperemesis, beyond the 16.-18. SSW persists beyond is unusual, but can lead to serious damage to the liver and cause a threatening centrilobular necrosis or an extended fatty liver cell degeneration and Wernicke encephalopathy or even oesophageal rupture. Diagnosis Clinical Investigation (sometimes repetitive weight measurements) ketone bodies in urine serum electrolytes and renal exclusion of other causes (eg. As acute abdomen) If the suspected diagnosis of hyperemesis is gravidarum, the ketone bodies in urine, the thyroid stimulating hormone (TSH) , serum electrolytes, blood urea nitrogen, creatinine, transaminases aspartate aminotransferase (AST) and alanine aminotransferase (ALT), magnesium, phosphate, and also the body weight determined. To rule out a molar pregnancy or multiple pregnancy a gynecological ultrasound should be performed. Other medical conditions that can trigger vomiting must be excluded; This information can include gastroenteritis, hepatitis, appendicitis, cholecystitis, other diseases of the biliary tract, stomach ulcers, intestinal obstruction, not by hyperemesis gravidarum caused hyperthyroidism (z. B. caused by Graves’ disease), gestational trophoblastic tumors, nephrolithiasis, pyelonephritis, diabetic ketoacidosis or gastroparesis, benign intracranial hypertension and migraine headaches. In addition to nausea and vomiting existing prominent symptoms often point to another cause. The relevant differential diagnostic tests are based on the findings of the laboratory, clinical and sonographic examination. Treatment Transient waiving oral feeding, followed by a gradual resumption liquids, thiamine, multivitamins and electrolytes as required antiemetics if necessary Initially does not take place, the supply orally. The initial treatment consists of intravenous fluids, starting with an infusion of 2 liters of Ringer’s lactate over 3 hours, to obtain a urinary excretion of> 100 ml / hour upright. Before any dextrose administration are first 100 mg thiamine i.v. given to prevent Wernicke’s encephalopathy. The Thiamindosis should be given daily for 3 days. The subsequent fluid requirements depend on the reaction of the patient, but may well be up to 1 liter every 4 hours for 3 days. Electrolyte deficiencies are compensated; Potassium, magnesium and phosphate are substituted as required. It must be ensured that the low sodium levels are not balanced too quickly, since too rapid correction osmotic Demyelinisierungssyndrom (n. D. Übers .: destruction of the myelin sheath in the pons cerebri, possibly by a toxic-metabolic process) to may follow. Emesis further continues after the first fluid and electrolyte replacement is treated as needed with an antiemetic; the antiemetics include vitamin B6 10-25 mg po every 8 h or every 6 h doxylamine 12.5 mg p.o. every 8 h or every 6 h (may additionally be taken to vitamin B6) promethazine p.o. 12.5-25 mg, i.m. or rectally every 4-8 h metoclopramide 5-10 mg i.v. or p.o. every 8 h ondansetron 8 mg p.o. or i.m. every 12 h Prochlorperazine 5-10 mg p.o. or i.m. every 3-4 h When dehydration and acute vomiting are eliminated, small amounts of fluid are given orally. Patients who can not tolerate oral liquid despite intravenous rehydration and Antiemetikagabe need to be hospitalized or receive an intravenous therapy under home conditions, if necessary, and may not receive enteral (in some cases over several days or longer) for an extended period. Do the patients once tolerated liquid again, they can eat small light meals; food structure is then as tolerated. At the beginning and until vitamins can be taken orally once again, a vitamin administration is i.v. required. If this treatment is ineffective, total parenteral nutrition may be required and, although controversial, corticosteroids are tried; z. B. methylprednisolone p.o. 16 mg every 8 hours or iv for 3 days, then for 2 weeks tapering off to the lowest effective dose. Corticosteroids should be <6 weeks, and used with extreme caution. They should not be taken during fetal organogenesis (between days 20 and 56 after fertilization); the use of this drug during the first trimester is slightly associated with the development of facial columns. The mechanism of action of corticosteroids on the nausea is unknown. With increasing weight loss, jaundice or persistent tachycardia despite appropriate therapy to terminate the pregnancy can be offered. Summary hyperemesis gravidarum, unlike morning sickness, can lead to weight loss, ketosis, dehydration and sometimes cause electrolyte imbalance. Other diseases that can cause vomiting must be excluded on the basis of symptoms in women. The severity is determined by measuring ketone bodies in urine. BUN, creatinine and body weight determined. First, it is dispensed with oral feeding, liquids and nutrients are i.v. optionally, oral ingestion is gradually restored and, antiemetics as needed.

Health Life Media Team

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