Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

746 Hypercholesterolemia Hyperemesis Gravidarum

■Uncontrolled patients every 3 months

➣Obtain lipid panel, ALT, AST

complications and prognosis

■Coronary artery disease

■Peripheral vascular disease

■Cerebrovascular disease

Hyperemesis Gravidarum..............................

CAROLINE A. RIELY, MD

history & physical

History

■Intractable nausea and vomiting in the first trimester

Signs and Symptoms

■Intractable vomiting, sensitive to food smells, hyperptyalism (exces-

sive spitting)

tests

Laboratory

■Elevated AST/ALT in 50% of cases, may be > 1,000

■Ketones in the urine

Liver Biopsy

■Normal, rarely hepatocyte dropout. Usually not indicated as diag-

nosis based on clinical findings

differential diagnosis

■Other causes of vomiting, such as gastric outlet obstruction from

ulcer (EGD may be indicated in severe cases)

■Viral hepatitis (+serologies, risk factors)

management

What to Do First

■Gut rest, IV rehydration

General Measures

■Antiemetics, including promethazine, odansetron, droperidol