Hyperemesis – what to do with morning sickness?
Unlike the transient nausea and vomiting that is normally experienced until about the 12th week of pregnancy, severe nausea is extreme and unremitting feeling nauseated and vomiting that persists after the 1st trimester. It usually occurs with the first pregnancy and commonly affects pregnant woman with conditions that produce high level of Human Chorionic Gonadotropin (hCG), such as gestational trophoblastic disease or multiple pregnancy.
This disorder occurs in about 7 out of 1000 pregnancies in African American and in about 16 out of 1000 pregnancies in White Americans. The prognosis is usually good. However, if untreated, extreme nausea produces substantial weight loss, starvation with ketosis and acetonuria (acetone in urine), dehydration with subsequent flid and electrolyte imbalance (hypokalemia – low level of potassium in the blood), and acid-base disturbances (acidosis or alkalosis). Retinal, neurologic, and renal damage may also occur.
What Cuases Hyperemesis Gravidarum?
The specific cause of nausea during pregnancy is unkown. Possible causes include pancreatitis (inflammation of the pancreas and elevated pancreatic serum are common), biliary tract disease, decreased secretion of free hydrochloric acid in the stomach, obstructive bowel disease, and vitamin deficiency (especially B6). In some mothers, this disorder may be
related to psychological factors.
What To Look For?
The patient typically complains of unremitting nausea and vomiting. The vomitus initially contains undigested foods, mucus, and small amount of bile. Later, it contains only bile and mucus. Finally, the vomitus includes blood and material that resembles coffee grounds.
The Body’s Other Response
Other symptoms of morning sickness includes thirst, hiccups, oliguria (scanty urination), vertigo, and headache as well as substantial weight loss and eventual emaciation caused by severe morning sickness. She may appear confused or delirious. Lassitude, stupor and possibly, coma may occur. Additional findings may include:
- Pale, dry, waxy and, possibly, jaundiced skin with decreased skin turgor;
- Dry, coated tongue;
- Subnormal or elevate temperature;
- Rapid pulse;
- Fetid, fruity breath (from acidosis).
What Tests Tell You?
Diagnostic tests are used to rule out disorder, such as gastroenteritis, cholecystitis, and peptic ulcer, which produce similar clinical effects. Differential diagnosis also rules out gestational trophoblastic disease, hepatitis (inflammation of the liver), inner ear infection, food poisoning, emotional problems, and eating disorder.
Urine test results show ketonuria (ketones in urine) and slight proteinuria (protein in urine). The following results of serum analysis support a diagnosis of hyperemesis:
- Decreased protein, chloride, sodium, and potassium levels;
- Increased blood urea nitrogen (BUN);
- Elevated hemoglobin levels;
- Elevated white blood cell count (WBC);
How Hyperemesis Gravidarum Is Treated?
Other possible causes, such as gastroenteritis, gall bladder disease, and pancreatic or liver disorders, must be ruled out before the diagnosis of nausea in pregnancy is confirmed. The mother with this condition may require hospitalization to correct electrolyte imbalances and prevent starvation. Intravenous Infusions (IVF) are used to maintain nutrition until she can tolerate oral feedings.
Infused While You Snooze – And Snack
An infusion of 3000 ml of IVF over 24 hours and food are usually withheld until there is no vomiting for 24 hours. The hyperemesis gravidarum treatment also includes nutritional adjustment. Clear fluids can be initiated. Metoclopramide (Reglan) may be administered to control vomiting. This infusion can be performed at the mother’s home in the presence of the visiting nurse. She progresses slowly to a clear liquid diet, then a full liquid diet, and finally, small, frequent meals of high-protein solid foods. A midnight snack helps stabilize blood glucose levels. Parenteral vitamin supplements and potassium replacements are used to help correct deficiencies.
Stop The Ride
If persisted vomiting jeopardizes the mother’s health, antiemetic medications may be prescribed. Note, however, that no drug has been approved by FDA for treatment of nausea and vomiting during pregnancy. Therefore, antiemetic must be prescribed with caution and the benefits must outweigh the risks of the mother and her fetus.
More commonly, however, a continuous IVF of the prescribed medication is administered through a portable IV pump worn under the mother’s clothes. The latter treatment is highly successful. After vomiting stops and the mothers electrolyte balance has been restored, the pregnancy usually continues without recurrence of hyperemesis gravidarum. Most mothers feel better as they begin to regain normal weight, but some continue to vomit throughout the pregnancy, requiring extended treatment. If appropriate, some patients may benefit from consultations with clinical nurse specialist, psychologist, or psychiatrists.
What To Do To Prevent Hyperemesis Gravidarum?
- Administer IVF as ordered until the mother can tolerate oral feedings;
- Monitor fluid intake and output, vital signs, skin turgor, daily weight, serum electrolyte levels, and urine for ketones;
- Anticipate the need for electrolyte replacement therapy;
- Provide frequent oral care;
- Suggest that the mother eat two or three dry crackers before getting out of bed in the morning to alleviate nausea;
- Provide reassurance and a calm, restful atmosphere.
- Encourage the mother to discuss her feelings about her pregnancy and the disorder.
- Help the mother develop effective coping strategies.