O21.0/1/9
DESCRIPTION
Recurrent vomiting leading to ketosis, generally in the first trimester.
Exclude:
- medical causes, e.g. thyrotoxicosis, and
- molar pregnancy.
GENERAL MEASURES
Counselling.
Frequent small, dry meals.
Avoid fatty and spicy foods.
Restrict oral intake for 24–48 hours, but ensure adequate intravenous hydration.
MEDICINE TREATMENT
Correct electrolyte imbalance with IV fluids.
- Pyridoxine, oral, 25 mg 8 hourly.
AND
- Metoclopramide, oral/IV, 10–20 mg 6 hourly as needed.
AND
- Vitamin B complex, IV, 10 mL.
In refractory cases :
Administer daily until hyperemesis is controlled:
- Dexamethasone, IM/IV, 4–8 mg daily.
AND
- Ondansetron, IV, 4–8 mg over 5 minutes, daily.
- Note: There is uncertainty regarding the safety of ondansetron in the first trimester. Use with caution and only when necessary.