From the Guidelines
For a 23-year-old female with hyperemesis gravidarum at 22 weeks pregnant being discharged from the ED, instructions should focus on managing nausea and preventing dehydration.
Discharge Instructions
To manage symptoms effectively, the following steps should be taken:
- Take ondansetron 4mg orally every 8 hours as needed for nausea, along with vitamin B6 25mg three times daily and doxylamine 12.5mg at bedtime, as recommended by the most recent guidelines 1.
- Stay hydrated by sipping small amounts of clear fluids frequently throughout the day, aiming for at least 2 liters daily.
- Eat small, frequent meals consisting of bland foods like crackers, toast, and rice, avoiding spicy, fatty, or strong-smelling foods.
Monitoring and Follow-Up
It is crucial to monitor for warning signs that require immediate return to the ED, including:
- Inability to keep fluids down for 24 hours
- Decreased urination
- Dizziness when standing
- Abdominal pain
- Fever above 100.4°F Continue prenatal vitamins as prescribed and follow up with your obstetrician within 2-3 days. Rest frequently and avoid triggers that worsen nausea. These measures help manage the increased levels of pregnancy hormones like hCG and estrogen that contribute to hyperemesis gravidarum, while the medications work to control the nausea center in your brain and stabilize your condition until the symptoms naturally improve, which typically occurs by 20 weeks but may persist throughout pregnancy in some cases, as noted in recent studies 1.
From the Research
Discharge Instructions for Hyperemesis Gravidarum
The following discharge instructions are recommended for a 23-year-old female with hyperemesis gravidarum at 22 weeks pregnant in the emergency department (ED):
- Continue antiemetic medication as prescribed by the physician to manage nausea and vomiting 2, 3
- Follow a dietary plan that includes small, frequent meals and bland foods to help manage symptoms 4
- Stay hydrated by drinking plenty of fluids, such as water and electrolyte-rich beverages 4, 5
- Monitor for signs of dehydration, such as dark urine, dizziness, and headaches, and seek medical attention if symptoms worsen 4, 5
- Follow up with an obstetrician within 24-48 hours to monitor fetal well-being and adjust treatment as needed 4, 3
Potential Complications
Be aware of the potential complications of hyperemesis gravidarum, including:
- Electrolyte imbalance and dehydration 4, 6, 5
- Weight loss and malnutrition 4, 6
- Thyroid dysfunction 6
- Pulmonary embolism (although rare) 5
- Wernicke's encephalopathy (a neurological emergency caused by vitamin deficiency) 5
Follow-up Care
Schedule follow-up appointments with an obstetrician to: