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ARTICLES IN THE BOOK

  1. Acute abdomen
  2. Acute coronary syndrome
  3. Acute pancreatitis
  4. Acute renal failure
  5. Agonal respiration
  6. Air embolism
  7. Ambulance
  8. Amnesic shellfish poisoning
  9. Anaphylaxis
  10. Angioedema
  11. Aortic dissection
  12. Appendicitis
  13. Artificial respiration
  14. Asphyxia
  15. Asystole
  16. Autonomic dysreflexia
  17. Bacterial meningitis
  18. Barotrauma
  19. Blast injury
  20. Bleeding
  21. Bowel obstruction
  22. Burn
  23. Carbon monoxide poisoning
  24. Cardiac arrest
  25. Cardiac arrhythmia
  26. Cardiac tamponade
  27. Cardiogenic shock
  28. Cardiopulmonary arrest
  29. Cardiopulmonary resuscitation
  30. Catamenial pneumothorax
  31. Cerebral hemorrhage
  32. Chemical burn
  33. Choking
  34. Chronic pancreatitis
  35. Cincinnati Stroke Scale
  36. Clinical depression
  37. Cord prolapse
  38. Decompression sickness
  39. Dental emergency
  40. Diabetic coma
  41. Diabetic ketoacidosis
  42. Distributive shock
  43. Drowning
  44. Drug overdose
  45. Eclampsia
  46. Ectopic pregnancy
  47. Electric shock
  48. Emergency medical services
  49. Emergency medical technician
  50. Emergency medicine
  51. Emergency room
  52. Emergency telephone number
  53. Epiglottitis
  54. Epilepsia partialis continua
  55. Frostbite
  56. Gastrointestinal perforation
  57. Gynecologic hemorrhage
  58. Heat syncope
  59. HELLP syndrome
  60. Hereditary pancreatitis
  61. Hospital
  62. Hydrocephalus
  63. Hypercapnia
  64. Hyperemesis gravidarum
  65. Hyperkalemia
  66. Hypertensive emergency
  67. Hyperthermia
  68. Hypoglycemia
  69. Hypothermia
  70. Hypovolemia
  71. Internal bleeding
  72. Ketoacidosis
  73. Lactic acidosis
  74. Lethal dose
  75. List of medical emergencies
  76. Malaria
  77. Malignant hypertension
  78. Medical emergency
  79. Meningitis
  80. Neuroglycopenia
  81. Neuroleptic malignant syndrome
  82. Nonketotic hyperosmolar coma
  83. Obstetrical hemorrhage
  84. Outdoor Emergency Care
  85. Overwhelming post-splenectomy infection
  86. Paralytic shellfish poisoning
  87. Paramedic
  88. Paraphimosis
  89. Peritonitis
  90. Physical trauma
  91. Placenta accreta
  92. Pneumothorax
  93. Positional asphyxia
  94. Pre-eclampsia
  95. Priapism
  96. Psychotic depression
  97. Respiratory arrest
  98. Respiratory failure
  99. Retinal detachment
  100. Revised Trauma Score
  101. Sepsis
  102. Septic arthritis
  103. Septic shock
  104. Sexual assault
  105. Shock
  106. Simple triage and rapid treatment
  107. Soy allergy
  108. Spinal cord compression
  109. Status epilepticus
  110. Stroke
  111. Temporal arteritis
  112. Testicular torsion
  113. Toxic epidermal necrolysis
  114. Toxidrome
  115. Triage
  116. Triage tag
  117. Upper gastrointestinal bleeding
  118. Uterine rupture
  119. Ventricular fibrillation
  120. Walking wounded
  121. Watershed stroke
  122. Wilderness first aid
  123. Wound
 



THE BOOK OF MEDICAL EMERGENCIES
This article is from:
http://en.wikipedia.org/wiki/Hyperemesis_gravidarum

All text is available under the terms of the GNU Free Documentation License: http://en.wikipedia.org/wiki/Wikipedia:Text_of_the_GNU_Free_Documentation_License 

Hyperemesis gravidarum

From Wikipedia, the free encyclopedia

 

Hyperemesis gravidarum (from the Latin for "extreme vomiting of the pregnant woman") is a severe form of morning sickness. According to the Hyperemesis Education and Research Foundation, hyperemesis gravidarum (HG) is described as "unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids." It is considered a rare complication of pregnancy. The exact number of sufferers is difficult to pinpoint because symptoms of nausea and vomiting during pregnancy exist on a continuum, and there is no clear boundary between common morning sickness and hyperemesis. Estimates of the percentage of pregnant women afflicted range from 0.3% to 2%.

Symptoms

When HG is severe and/or inadequately treated, it may result in:

  • loss of 5% or more of pre-pregnancy body weight
  • dehydration and ketosis
  • nutritional deficiencies
  • metabolic imbalances
  • difficulty with daily activities

Some women with HG lose as much as 20% of their body weight. Many sufferers of HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms. This is known as hyperolfaction. Ptyalism, or hypersalvation, is another symptom experienced by some, but not all, women suffering from HG.

As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy and last significantly longer. While most women will experience near-complete relief of morning sickness symptoms near the beginning of their second trimester, some sufferers of HG will experience severe symptoms until delivery. A chart comparing morning sickness to HG can be found here.

Complications

For the pregnant woman

If inadequately treated, HG can cause renal failure, central pontine myelinolysis, coagulopathy, atrophy, Mallory-Weiss syndrome, hypoglycemia, jaundice, malnutrition, Wernicke's encephalopathy, pneumomediastinum, rhabdomyolysis, deconditioning, splenic avulsion and vasospasms of cerebral arteries. Depression is a common secondary complication of HG.

Charlotte Brontë is believed to have died from HG.

The serious, and sometimes fatal complications of HG are almost always avoided with aggressive treatment.

For the fetus

No long-term follow-up studies have been conducted on children of hyperemetic women. Children born to hyperemetic women appear to have no greater risk of complications or birth defects than the general population. However, recent research in fetal programming indicates that prolonged stress, dehydration and malnutrition during pregnancy can put the fetus at risk for chronic disease, such as diabetes or heart disease, later in life. This underscores the importance of aggressive treatment of the condition.

Treatment

Because of the potential for severe dehydration and other complications, HG is generally treated as a medical emergency. Treatment of HG may include antiemetic medications and intravenous rehydration. If medication and IV hydration are insufficient nutritional support may be required.

Management of HG can be complicated because not all women respond to treatment. Coping strategies for uncomplicated morning sickness, which may include eating a bland diet and eating before rising in the morning, may be of some assistance but are unlikely to resolve the disorder on their own. There is evidence that ginger may be effective in treating pregnancy-related nausea, however this is generally ineffective in cases of HG.

IV hydration

IV hydration often includes supplementation of electrolytes as persistent vomiting frequently leads to a deficiency. Likewise supplementation for lost thiamine (Vitamin B1) must be considered to reduce the risk of Wernicke's encephalopathy.[1]

After IV rehydration is completed, patients generally progress to frequent small liquid or bland meals. After rehydration, treatment focuses on managing symptoms to allow normal intake of food.

Medications

While no medication is considered completely risk-free for use during pregnancy, there are several which are commonly used to treat HG and are believed to be safe.

The standard treatment in most of the world is Benedictin, a combination of doxylamine succinate and vitamin B6. However, due to a series of birth-defect lawsuits in the United States against its maker, Merrill Dow, Benedictin is not currently on the market in the U.S. (None of the lawsuits were successful, and numerous independent studies and the Food and Drug Administration (FDA) have concluded that Benedictin does not cause birth defects.) Its component ingredients are available over-the-counter (doxylamine succinate is the active ingredient in many sleep medications), and some doctors will recommend this treatment to their patients.

Antiemetic drugs, especially ondansetron (Zofran), are effective in many women. The major drawback of ondansetron is its extremely high cost. In severe cases of HG, the Zofran pump may be more effective than tablets. Metoclopramide is sometimes used in conjunction with antiemetic drugs; however, it has a somewhat higher incidence of side effects. Other medications less commonly used to treat HG include corticosteroids and antihistamines.

Practice in United Kingdom

The practice in the United Kingdom, following the thalidomide tragedy, is to generally use older drugs for which there has been a greater experience of use in pregnancy. Hence the first choice drug is promethazine with second choice being either metoclopramide or prochlorperazine; with the administration of thiamine strongly recommended.[1]

Nutritional support

Women who do not respond to IV rehydration and medication may require nutritional support. Patients might receive parenteral nutrition (intravenous feeding via a PICC line) or enteral nutrition (via a nasogastric tube or a nasojejunum tube).

Complementary and alternative medicine

Some women with HG find relief with complementary or alternative medicine, including chiropractic, homeopathy, acupuncture and energy psychology.

Cause

The cause of HG is unknown. The leading theories speculate that it is an adverse reaction to the hormonal changes of pregnancy. In particular Hyperemesis may be due to raised levels of beta HCG (Human Chorionic Gonadotrophin) as it is more common in multiple pregnancies and in gestational trophoblastic disease.

Additional theories point to high levels of estrogen, which may also be to blame for hypersalivation; decreased gastric motility (slowed emptying of the stomach and intestines); immune response to fragments of chorionic villi that enter the maternal bloodstream; or immune response to the "foreign" fetus.[citation needed]

Historically, HG has been blamed upon a psychological condition of the pregnant women. Medical professionals believed it was a reaction to an unwanted pregnancy or some other emotional or psychological problem. This theory has been disproved, but unfortunately some medical professionals espouse this view and fail to give patients the care they need.

Understanding its Impact

According to the Hyperemesis Eduction and Research Foundation (HER), conservative estimates indicate that HG can cost a minimum of $200 million annually in inhouse hospitalizations to treat the condition. Note that this figure does not include emergency room visits, and other types of assitance, so the figure is in actuality quite higher. Beyond the immediate financial impact, many families dissolve due to the stress of HG and women can suffer long term health consequences. Many women also lose their employment due to HG and decide to limit their family size rather than experience another HG pregnancy.

Supporting Women in the Midst of HG Pregnancy

It is important that women get early and aggressive care during pregnancy. This can help limit the complications of HG. Also, due to the fact that depression can be a secondary condition of HG, emotional support, and sometimes even counseling, can be of benefit. It is important, however, that women not be stigmatized by the suggestion that the disease is being caused by psychological issues. For a more complete list of survival and support information, download the HER survival guide at [1]

Footnotes

  1. ^ a b British National Formulary (March 2003). “4.6 Drugs used in nausea and vertigo - Vomiting of pregnancy”, "BNF", 45.

External links

  • Hyperemesis Education & Research Foundation
  • Pregnancy @ about.com
  • University of Maryland Medical Center Hyperemesis site
Retrieved from "http://en.wikipedia.org/wiki/Hyperemesis_gravidarum"

 

 

 

 

 
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