This document provides guidelines for managing severe vomiting during pregnancy (hyperemesis gravidarum), including administering IV fluids for rehydration, monitoring vital signs and lab work daily, supplementing vitamins, using anti-emetic drugs, and considering termination of pregnancy in severe, unresponsive cases. It recommends withholding oral feeding for 24 hours and providing 3 liters of IV fluids split between dextrose and Ringer's solution over that time along with additional crystalloids as needed based on vomit and urine output.

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

14. THANK YOU …