O+G
HYPEREMESIS
PromptBlood gas
ResponseMetabolic alkalosis from vomiting (look at delta ratio)
HAGMA from starvation ketosis (look at anion gap - gap is ketones)
HAGMA from starvation ketosis (look at anion gap - gap is ketones)
PromptManagement
ResponseAnswer
Antiemetics - metoclopromide 10 mg IV
Correct hydration - IV hartmann’s >> PO replacement when able
Correct Ketoacidosis (If present) - dextrose infusion
Replace electrolytes
eTG
Non pharmacologic - Small meals frequently, maintain hydration, high protein snacks between meals, crackers/plain biscuits on getting out of bed
Pharm
First line - Pyridoxine 12.5mg mane + 25 mg nocte + doxylamine 25 mg nocte
2nd line - Metoclopromide, ondansetron, Prochlorperazine (PO/IV)
Antiemetics - metoclopromide 10 mg IV
Correct hydration - IV hartmann’s >> PO replacement when able
Correct Ketoacidosis (If present) - dextrose infusion
Replace electrolytes
eTG
Non pharmacologic - Small meals frequently, maintain hydration, high protein snacks between meals, crackers/plain biscuits on getting out of bed
Pharm
First line - Pyridoxine 12.5mg mane + 25 mg nocte + doxylamine 25 mg nocte
2nd line - Metoclopromide, ondansetron, Prochlorperazine (PO/IV)