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Parenteral Fluid Therapy
1.
2. After the cessation of vomiting
Oral feeding is withheld for at least 24 hrs
During this period fluid is given through intravenous drip
method
3. The amount of fluid to be infused in 24 hrs is calculated
as :
Total amount of fluid = 3 liters
Half is 5 % dextrose & half is Ringer’s solution
Extra amount of crystalloids ( normal saline or ringer
lactate ) = amount of vomitus & urine in 24 hrs
4. This regime rectifies :
Dehydration
Ketoacidosis
Water & electrolyte imbalance
Serum electrolytes should be estimated & corrected if
abnormal
Enteral nutrition through nasogastric tube may also be given
5. INTRAVENOUS THIAMINE ( Vitamin B1 ) : 100 mg in 100
ml normal saline ( slowly over 30 mins )
To prevent Wernicke’s encephalopathy
In severe cases in which prolonged IV hydration is
anticipated
Parenteral nutrition & vitamin supplementation may be
given ( vitamin B6 , B12 , C , K )
6. Blood transfusion can be done only if patient is severely
anemic
IV fluids are given until vomiting is controlled
After rehydration most of the patients can be discharged
But if vomiting is persistent they are usually admitted
7. Anti – emetics are given parenterally like :
Drug Dosing Route
Phenothiazines
Promethazine (Phenergan)
Prochlorperazine
Triflupromazine
Every 6 hr
12.5–25 mg
5–15 (25 PR) mg
10mg (12hrly)
IM , IV
IM , IV
IM
Serotonin antagonist
Ondansetron
Every 8 hr
8 mg IV
Benzamides
Metoclopramide
Every 6 hr
5–15 mg IM , IV
8. HYPEREMESIS PROGRESS CHART
ASSESS THE PROGRESS OF PATIENT IN HOSPITAL
DAILY RECORDS OF :
1. Pulse, blood pressure and temperature at least twice daily
2. Urine for acetone, protein and bile
3. Blood biochemistry
4. ECG (when serum potassium is impaired.)
9. CLINICAL FEATURES OF IMPROVEMENT
SUBSIDENCE OF VOMITING
FEELING OF HUNGER
BETTER LOOK
NORMALISATION OF BLOOD BIOCHEMISTRY
10. DISAPPEARANCE OF ACETONE FROM BREATH AND
URINE
NORMAL PULSE AND B.P.
NORMAL URINE OUTPUT
11. DIET
STARTED BEFORE I.V. FLUIDS ARE OMITTED.
SMALL BUT FREQUENT FEEDS OF DRY CARBOHYDRATE
FOODS.
GRADUALLY FULL DIET IS RESTORED.
12. TERMINATION OF PREGNANCY
Indications :
Persistent severe vomiting after 1 week of treatment
Pulse is persistently above 100 / min
Temperature persistently above 38° C
Systolic blood pressure is persistently below 100
mmHg
13. Jaundice or bile in urine
Anuria , persistent albuminuria , high blood urea
Wernicke’s encephalopathy
If ECG is abnormal
Rarely indicated