Hyperemesis

Question 1

% of NVP and HG

Answer 1

NVP- 80% women
HC- 0.3-3.6%

Question 2

Timing

Answer 2

• 1st T- 4-7 weeks
• If >10+6, consider other causes

Question 3

HG diagnosis

Answer 3

• Uncontrollable NVP
  +
  5% wt loss or
  dehydration or
  electrolyte imbalance

Question 4

Scores for NVP

Answer 4

Rhodes index
PUQE score

Question 5

History to note

Answer 5

• Prev NVP
• UTI symptoms
• Abdo pain
• Other infections- Viral GE, cholecystitis

Question 6

Investigations

Answer 6

• Bloods- FBC, U+E, HCG- incase of moalr, TFT, LFT, Calcium, amylase, BM
• Urine dip +/- MSU
• USS - exclude multiple preg, molar etc

Question 7

Electrolyte changes

Answer 7

• Low Na/K
• Low Ur
• High HCT
• Ketonuria
• Metabolic acidosis - if severe HG

Question 8

TFT abnormality- mx

Answer 8

• DO NOT Treat
• 60% will have lab hyper-thyroid
• Clinically euthyroid
• Will improve as HG resolves

Question 9

Management

Answer 9

• Most can be mx in community
• Day care centre if IVI needed
• If recurrent and not improving then admit

Question 10

Antiemetics

Answer 10

1st line: Cyclizine, promethazine, prochlorperazine

2nd line: Metoclopramide (short term), Domperidone, Ondansetron (>12w)

3rd line: Steroids

Question 11

Ondansetron SE

Answer 11

• Cleft palate
• CV defects

Question 12

Complimentary therapies

Answer 12

• Ginger
• Acupuncture

Do not advise hypnosis.

Question 13

Other treatments to help

Answer 13

• H2 recep antagonist- Omeprazole
• Abx if UTI/ infection
• Thiamine
• LMWH if admitted

Question 14

Follow up

Answer 14

• Individual plans
• If NVP cont to 2nd/3rd T- Serial scans