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Hyperemesis Gravidarum


The diagnosis is uncommon in persons greater than 20 weeks gestation anyhow



Inclusion Criteria

  • Dehydration (mild to moderate)
  • Ketonuria
  • < 20 weeks pregnant
  • Stable vital signs
  • Ob/Gyn service or attending contacted & agrees
  • Minimally abnormal lab values that are correctable by IV fluids

Exclusion Criteria

  • Pregnancy > 20 weeks
  • Unstable vital signs, severely abnormal lab values
  • Severely dehydrated
  • Urinary tract infection in pregnancy

Potential Interventions

  • IV – D5LR or D5NS at 250 cc/hr until urine ketones clear, then 150 cc/hr
  • Diet - ice chips advanced to clear fluids, dry diet when tolerate fluids
  • Antiemetics: Zofran 4mg q6-hprn, Tigan 200mg IM q-6-h prn, Compazine 5-10mg IV or IM q-6-h prn,
  • Dietary counseling
  • Disposition Criteria Rapid followup with OBGYN

Discharge Criteria

Home

    • Stable vital signs, normal labs, urine ketones cleared
    • Taking oral fluids
    • Absence of significant nausea, no vomiting

Admit

    • Unstable vital signs
    • Uncorrected or worsening lab values
    • Unable to tolerate oral fluids
    • Private attending or EDP chooses admission


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