Diagnosis of Hyperemesis Gravidarum in Patients with Pregnancy- Induced Vomiting Using a Point-of-Care Ketone Blood Test

Hyperemesis Gravidarum: A Holistic Review and Approach to Etiopathogenesis, Clinical Diagnostic and Management Therapy

“…The most commonly cited criteria for the diagnosis of HG include persistent vomiting not related to other causes, an objective measure of acute starvation (usually large ketonuria on urine analysis), electrolyte abnormalities, and acid-base disturbances such as hypochloremic alkalosis, hypokalemia, and hyponatremia, as well as weight loss. 7,20,22,44 Ultrasound examination may confirm viability and gestational age also identify a predisposing factor such as multiple pregnancies or molar gestation. 2,20,45 Nausea and vomiting in HG can be categorized based on its severity using a validated questionnaire, known as pregnancyunique quantification of emesis and nausea (PUQE) scoring index shown in Table 1.…”

“…20,45 The use of normal saline/NaCl 0.9% and ringer lactate (RL) is preferably 21,48,49 compared to dextrose because dextrose increases the incidence of Wernicke's encephalopathy. 21,44 Supplementation with thiamine 100 mg 7,21,48 may prevent the occurrence of Wernicke's encephalopathy. 7,20,45 Nutrition with enteral tube feeding (nasogastric, nasojejunal) was initiated in refractory cases, patients who were unresponsive to drug therapy and unable to maintain their weight.…”

“…7,20,45 Nutrition with enteral tube feeding (nasogastric, nasojejunal) was initiated in refractory cases, patients who were unresponsive to drug therapy and unable to maintain their weight. 22,44,46 Total parenteral nutrition was given to patients who did not respond to antiemetic therapy and can't be managed with enteral nutrition. 45,49…”

“…Common dietary recommendations include consumption of bland foods, eat small meals but often, avoid an empty stomach, avoid spicy and fatty foods, 2,20,22,[46][47][48][49][50] give time between eating and drinking as well as drinking small and frequently. 46,48,49 Lifestyle modification involves identifying and avoiding the triggers of nausea and vomiting, 20,44 preventing stress, and taking rest as much as possible. 20,46,49 Psychotherapy and replacing iron-free multivitamins with folic acid supplementation may be recommended.…”

“…20,46,49 Psychotherapy and replacing iron-free multivitamins with folic acid supplementation may be recommended. 20,22,[47][48][49][50] ACOG recommends ginger as a nonpharmacological intervention 20,44 that can improve nausea but not to reduce vomiting. [20][21][22]49 Ginger contains gingerol and shogaol that inhibit 5-HT3 serotonergic receptors and inhibit the growth of H. pylori.…”