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Key Features

  • Persistent severe vomiting during pregnancy

Clinical Findings

  • Weight loss

  • Dehydration

  • Starvation ketosis

  • Hypochloremic alkalosis

  • Hypokalemia

  • Mild elevation in liver enzymes

Diagnosis

  • Pregnancy test (β-hCG)

  • Thyroid-stimulating hormone (TSH) and free T4 should be checked because thyroid dysfunction can be associated

Treatment

  • Hospitalization with nothing by mouth and intravenous fluids and vitamins as indicated

  • Antiemetics

    • Promethazine, 25 mg orally, rectally, or intravenously every 4–6 hours

    • Metoclopramide, 10 mg orally or intravenously every 6 hours

    • Ondansetron, 4–8 mg orally or intravenously every 8 hours

      • Has been associated in some studies with congenital anomalies

      • Data are limited, but the risks and benefits of treatment should be addressed with the patient

  • As soon as possible, start a dry diet with 6 small daily feedings

  • Once stabilized, patients may remain at home, even if intravenous fluids are required

  • To limit the risk of teratogenicity, drug use in the first half of pregnancy should be limited to those of major importance to life and health (Tables 19–1 and 19–2)

  • Total parenteral nutrition is rarely necessary

Table 19–1.Common drugs that are teratogenic or fetotoxic.1
Table 19–2.Drugs and substances that require a careful assessment of risk before they are prescribed for breastfeeding women.1

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