Hi, I'm Cathy with Level Up RN. In this episode of Ask a Nurse, I'll be answering your questions about hyperemesis gravidarum, which, unfortunately, I know a lot about because I suffered from this condition in both my pregnancies. I'll be answering questions such as, "What is hyperemesis? What causes hyperemesis? And how is hyperemesis diagnosed and treated?" Hyperemesis gravidarum is a condition that causes severe nausea and vomiting during pregnancy, which can lead to weight loss, dehydration, and electrolyte imbalances. So to be clear, hyperemesis is not the same as morning sickness. Morning sickness typically occurs during the first trimester of pregnancy and is limited in severity. Hyperemesis symptoms, on the other hand, often last much longer and are much more severe. In my case, my symptoms were so severe that I had to be hospitalized many times and received nutritional support through an IV. The exact cause of hyperemesis gravidarum is unknown. Some studies show an association with rising levels of human chorionic gonadotropin, or HCG, and/or estrogen levels during pregnancy. In addition, hyperemesis is more common if you are pregnant with twins or more babies, or if you have something called a hydatidiform mole, which is an abnormal mass that grows in the uterus during the first part of pregnancy. Hyperemesis is also more common in individuals with a history of motion sickness or migraines and in those who have a family history of hyperemesis.
Symptoms of hyperemesis include severe nausea and vomiting, food aversions, weight loss, dehydration, extreme fatigue, weakness, a low blood pressure, a rapid heart rate, and depression and/or anxiety. To diagnose hyperemesis, your provider will obtain information about your health history and symptoms and perform a physical exam. Lab work may also be ordered, which can include blood tests as well as urine tests. With severe hyperemesis, electrolyte imbalances may be present, such as low levels of sodium and potassium. And then ketones may be found in the urine as well. And then with severe dehydration, this can lead to acute kidney injury, which will cause an increase in creatinine and BUN levels.
Treatment of hyperemesis typically follows a stepwise approach. Initial treatment may include ginger supplementation, acupressure wristbands, and lifestyle modifications that we will talk about in more depth in this video. If nausea and vomiting continue despite these interventions, then your provider may recommend that you take a combination of vitamin B6 and doxylamine. And then if this is not effective, there are a variety of antiemetic drugs, which are drugs that help prevent vomiting, that can be prescribed. Examples include ondansetron, promethazine, and metoclopramide, just to name a few. Then if you are like me and none of those medications are particularly helpful, you may require admission to the hospital for administration of IV fluids and electrolytes. And then if you are unable to take in the nutrients that you and your baby need, you may need to get those nutrients through a feeding tube or IV. I also wanted to mention that prednisolone, which is a steroid, has been shown to be effective in severe hyperemesis that is resistant to treatment. So this is what I ultimately ended up taking during my second pregnancy, and it made a huge difference for me. And I was able to stop getting nutrition through an IV. However, you will definitely want to talk to your doctor about the benefits and risks of any medication that you take during pregnancy.
Let's now touch on some lifestyle modifications which may help improve your symptoms. So first of all, you want to avoid any triggers, which can include certain smells, certain noises, or riding in the car, for example. And then you want to focus on eating and drinking when you are best able to do so. So for example, mornings were a little better for me, and then my symptoms would get progressively worse throughout the day. So I really focused on trying to get as much nutrition in as I could earlier in the day. You can also try eating more dry and bland foods that are easier to digest as opposed to fatty or fried foods. But everyone is different, and you need to figure out what foods are going to go down and stay down the best for you. And then drinking fluids between meals as opposed to with meals can help decrease nausea when eating. And then some people find that carbonated beverages, such as ginger ale and seltzers, are easier to drink.
Finally, I just want to say that if you are suffering from hyperemesis, you are not alone, even though it can feel that way sometimes. This is an incredibly debilitating condition, and people around you, even people who love you greatly, will never fully understand or appreciate what you are going through. Connecting online with others who have hyperemesis can help you feel a little less alone. And then finding a provider that takes your symptoms seriously and works hard to find therapies to help you is essential as well. All right. That is it for this episode of Ask a Nurse. Thank you for watching. Stay informed and stay well.
