Nausea & Vomiting - NICE/GTG Flashcards
Draw out the PUQE Index
PUQE score what are the score cut offs for
i) Mild
ii) Moderate
iii) Severe
i) Mild <6
ii) Moderate 7-12
iii) Severe >13
To be defined at hyperemesis gravid arum, where parameters should be met?
Protracted vomiting, >5% weight loss, dehydration or electrolyte imbalance
When is ambulatory care suitable?
PUQE score <13, community care failed
When should inpatient management be advised?
Continued N+V, >5% weight loss despite PO antiemetics, suspected/confirmed co-morbidty
What is first line antiemetics and is their class?
H1 receptor antagonist - promethazine/cyclizine
Phenothiazine - prochlorperazine
What is the main side of effect of the 2nd line anti-emetic, metoclopromide?
Which anti-emetic can increase the risk of this side effect?
Extrapyramidal symptoms, oculogyric crisis.
Phenothiazine - prochlorperazine
What class of antiemetic is ondansetron?
Serotonin 5-HT3 receptor antagonists
What is the risk of cleft palate with ondansetron?
3 oral clefts per 10,000 births (14 cases per 10,000 births versus 11 cases per 10,000 births in the unexposed population).
What dose of steroids should be given?
IV hydrocortisone 100mg BD or Prednisalone 40-50mg OD
Which IV fluids can precipitate Wernickes encephalopathy?
Dextrose
What supplement should be given to prevent wernickes encephalopathy?
High dose thiamine B1 100mg
In severe hyperemesis which other teams should be included in the patients care?
Midwife
Dietician
Gastroenterologist
Mental health team
If symptoms persist into 2nd or 3rd trimester, what additional care should be provided?
Serial Growth USS
ANC
Psychological and social support
Discuss risk of preterm delivery
Name a hyperemesis support group
Pregnancy sickness support
