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16. Vomiting In Pregnancy
Hi guys I am back with another video , in this video we will be discussing about the vomiting in pregnancies , so vomiting in pregnancies is a very common in a pregnant lady ; it is also called morning sickness and it can happen at any time in a day. It starts from the onset of pregnancy until 16 weeks, it usually subsides . What are the causes of vomiting in pregnancy ?
Higher level of HCG
Higher level of estrogen
Higher level of progesterone
Thyroxine
Prolactin and placental growth hormone
Now let us understand the hyperemesis gravidarum, it is a severe case of nausea and vomiting which leads to Dehydration, electrolytes and acid base imbalance which leads to hypokalemia and alkalosis.
It causes starvation and ketosis because when a woman vomits more fats in her body are being utilized but at the cost of producing ketone bodies. Ketone bodies induces more and more vomiting . Liver damage and jaundice can occur in some cases , rule out the other causes as this is as diagnosis of exclusion . So other causes must be environmental and female fetus increases the risk whereas smoking decreases the risk .important causes of late pregnancy vomiting are: pre eclamptic toxemia and fatty liver . The complications of hyperemesis are esophageal tears, diaphragmatic rupture, acute kidney injury due to dehydration. Decreased potassium causing cardiac arrhythmias, coagulopathy due to vit k deficiency .
In case of treatment in obstetrics we can give a diet modification to the patient that is we can ask the patient to split the meals , I mean not to take a bunch of meal in one take , so that it would be easier for the patient to cope up with the situation .
The tablet given in case of mild vomiting are Tab Doxylamine+ B6 ( pyridoxine )
In case of moderate vomiting are prochlorperazine , promethazine and metoclopramide which is given orally and ondansetron which is given rectally . In case of severe vomiting the IV hydration is given which includes normal saline , ringer lecture and dextrose and Anti Emetics is given which includes IV promethazine , IV prochlorperazine , IV ondansetron , IV metoclopramide and add 100 g of Thiamine . Overdose of ondansetron causes serotonin syndrome. What is serotonin syndrome? Now it is a classical triad which includes Neuromuscular hyperactivity, ANS over activity ,Altered mental status .
The neuromuscular hyperactivity causes : muscle rigidity , hyperkinesis and seizures .
ANS overactivity causes increased HR ,diaphoresis and hyperthermia .
Altered mental status causes agitation , confusion and anxiety .
So this is what we have known here , see you in the next video , thank you !
