,# Hyperemesis Gravidarum
Overview
حازم
Causes and Symptoms
High HCG Levels
High levels of Human Chorionic Gonadotropin (HCG) are associated with the condition:
- Nausea
- Vomiting
Symptoms typically start around the 7th week of pregnancy starts to decrease from 12-13 wks
HCG Levels and Symptom Regression
- 7-8 weeks: ↑HCG
- Plateau phase
- 12-13 weeks: ↓HCG
Symptoms usually regress after 12-13 weeks, but persistent symptoms may indicate:
- Molar pregnancy
- Malignancy
- Multiple pregnancy
So if patient came to u with persistent symptoms from 7-13 weeks ?
- hyperemesis gravidarum
Clinical Presentation
A 28-year-old woman, gravida 2 para 1, presents at 10 weeks of gestation with:
- Persistent nausea and vomiting for two weeks
- Inability to keep food or fluids down
- 5 kg weight loss
- Dizziness and weakness
- Dehydration with dry mucous membranes and tachycardia (110 bpm)
- Laboratory tests reveal ketonuria, hyponatremia, and hypokalemia
Consequences of Hyperemesis Gravidarum
Dehydration, Electrolyte Disturbance, and Ketonuria
- Dehydration
- Electrolyte disturbance
- Ketonuria
- Electrolyte disturbance
- Dehydration
- Ketonuria
- Ketonuria
- Dehydration
- Electrolyte disturbance
Signs and Symptoms
- Dehydration
- Weight loss due to starvation
- Electrolyte disturbance (vomiting = loss of K+, Diarrhea = loss Na)
- Ketonuria
- Long-term starvation can cause thiamine (Vitamin B1) deficiency, leading to a dementia-like syndrome (Korsakoff’s)
Differential Diagnosis
- DKA (Diabetic Ketoacidosis)
- GERD (Gastroesophageal Reflux Disease)
- Gastritis
- Cholecystitis
- Meningitis
- Otitis media
- UTI (Urinary Tract Infection)
Investigations
Laboratory Tests
- CBC (Complete Blood Count)
- Fasting blood glucose
- Urinalysis (WBC for infection, ketone bodies)
- KFT (Kidney Function Test) to check for Acute Renal Failure (ARF)
- LFT (Liver Function Test)
- TFT (Thyroid Function Test) because HCG mimics Thyroid hormone
Imaging
- Ultrasound if suspecting:
- Molar pregnancy
- Ectopic Pregnancy (EP)
Management
- Admission
- IV fluid (Normal saline, Ringer lactate) at a slow rate to prevent pontine demyelination + Electrolyte and thiamine repletion
- Antiemetic (Metoclopramide, domperidone)
- After stabilizing the patient, add dextrose (orally or IV)
- For recurrent vomiting with blood (Mallory-Weiss syndrome), give PPI (Proton Pump Inhibitor)
- If no improvement, check for psychological cause
