Hyperemesis Gravidarum

Severe and prolonged nausea and vomiting during pregnancy, typically occurring between 8-12 weeks of gestation but may extend up to 20 weeks.

1. Dehydration: IV fluids are the primary initial treatment.
2. Signs of dehydration: Ketonuria, tachycardia, weight loss, sunken eyes, poor skin turgor, and prolonged capillary refill.

Complications:

i. Wernicke’s Encephalopathy: Risk due to prolonged vomiting; thiamine supplementation is important.
ii. Mallory-Weiss Tear: Severe vomiting can cause tears in the oesophagus leading to hematemesis.

Management (F.A.S.T)

Fluids

IV Fluid Rehydration: Essential for treating dehydration.
Electrolyte Balance: If potassium is low (<3.5 mmol/L), administer normal saline (0.9% NaCl) with 20-40 mmol/L of potassium chloride.

Antiemetics

First-line: Cyclizine, promethazine (antihistamines).
Second line: Metoclopramide, ondansetron (dopamine antagonists).
Third line: IV hydrocortisone (steroids) for severe cases.

Steroids
Used in resistant cases, hydrocortisone is given intravenously.

Thiamine
Supplementation to prevent Wernicke’s encephalopathy, particularly if prolonged vomiting is observed.