Hyperemesis gravidarum during pregnancy: What hospitalists should know

NATIONAL HARBOR, Md. — Although many hospitalists are often not comfortable with pregnant patients because they don't see very many, diagnosing and managing hyperemesis gravidarum is critical, according to a speaker at Hospital Medicine 2019.

Differentiating morning sickness from hyperemesis gravidarum, which leads to thiamine and vitamin K deficiency and is characterized by dehydration, weight loss, electrolyte imbalances, abnormal thyroid tests without thyroid disease and severe nausea and vomiting, can be challenging, according to Karyn Kolman, MD, vice chair of education in the department of family and community medicine at the University of Arizona College of Medicine – Tucson.

Due to the “toll” the nausea and vomiting associated with hyperemesis gravidarum takes on women, some seek termination “because of how badly they feel,” Kolman said.

While women typically present with hyperemesis gravidarum before 9 weeks gestation and improve after 20 weeks, Kolman noted that it is possible for the condition to occur at any time and last for the duration of the pregnancy.

To manage the condition, Kolman suggests providing appropriate nutrition as well as IV fluids without dextrose, but with thiamine, and discharge medications for nausea. Antithyroid medications are not needed since the hyperthyroidism that occurs when a patient has hyperemesis gravidarum is usually transient.

Kolman said hospitalists should also be aware that domestic violence increases during pregnancy.

“If the patient keeps getting admitted with nausea and vomiting, it is worth making sure that this isn’t someone who keeps coming back because she’s not safe at home.” – by Melissa J. Webb

Reference:

Kolman K. What to expect when your patient is expecting: Management of the hospitalized pregnant patient. Presented at: Hospital Medicine 2019. March 25-27; National Harbor, Md.

Disclosures: Kolman reports no relevant financial disclosures.