What IV Fluids are Best for Hyperemesis Gravidarum?
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Hyperemesis gravidarum (HG) is a rare but severe condition that typically begins in the first trimester and peaks in the third. Women who develop HG are often unable to get out of bed, unable to keep any food or liquids down, experience nausea and vomiting so disruptive it becomes their primary focus, and requires hospitalization for dehydration. Because no one knows why some women develop HG and others do not, there is no cure and little consensus on what IV fluids are best for women with HG. This article covers the different IV solutions and the pros and cons of each for women struggling with HG.
What is Hyperemesis Gravidarum?
Hyperemesis gravidarum (HG) is a severe form of morning sickness characterized by frequent and persistent nausea, vomiting (sometimes every 15 minutes or more), and significant weight loss. It affects 1 in every 200 pregnant women and is more common in mothers-to-be with a history of motion sickness or migraines. Because no one knows why some women develop HG and others do not, there is no cure and little consensus on what IV fluids are best for women with HG. Currently, there is no standard of care for HG, meaning different doctors and hospitals use different protocols for treating it.
IV Fluids to Treat Dehydration from Hyperemesis Gravidarum
Normal saline: Normal saline is the most common IV fluid used to treat dehydration from HG. However, this may be suboptimal because it does not contain any specific electrolytes. Normal saline is simply a mix of water and sodium chloride (salt). In fact, many doctors avoid normal saline entirely, preferring to use 0.9% sodium chloride (hypertonic saline) instead. When to use normal saline: Normal saline is best for replenishing lost fluids and electrolytes. If a patient has a blood sugar issue, normal saline can be used to give the patient sugar intravenously. When not to use normal saline: If a patient has a blood pressure issue, normal saline should not be used. Normal saline is isotonic, meaning it has the same concentration of electrolytes as in the bloodstream.
The patient has low blood pressure
This can be problematic if a The patient has low blood pressure, since a fluid infusion can make it harder for the heart to pump blood. Hypertonic saline: Hypertonic saline is a special IV solution containing more electrolytes than normal saline. This can be helpful in treating HG, as the vomiting and diarrhea that can accompany it can cause electrolyte imbalances. When to use hypertonic saline: Hypertonic saline is best for treating low blood pressure, which can occur with IV fluid replacement. When not to use hypertonic saline: Hypertonic saline should not be used if a patient has high blood pressure or a blood sugar issue. IV Vitamin and Mineral Supplementation Vitamin and mineral supplements given by IV can be helpful for treating the nutritional deficiencies that can occur with HG. However, given the risks associated with high-dose vitamin and mineral supplements, IV supplementation should be carefully monitored by a doctor. There are two ways to give vitamins and minerals IV. The first is to mix them into the IV fluids. The second is to give them as a separate IV. If vitamins and minerals are mixed into the IV fluids, they should be given in very low doses because too much can cause harmful side effects. If vitamins and minerals are given as a separate IV, they should be given in much higher doses because they will be diluted in the amount of fluids given.
Conclusion
Hyperemesis gravidarum is a severe form of morning sickness experienced by a small minority of pregnant women. It is characterized by frequent and persistent nausea, vomiting, and significant weight loss. Because no one knows why some women develop HG and others do not, there is no cure and little consensus on what IV fluids are best for women with HG. For severe dehydration, IV fluids can be used to rehydrate patients quickly. Although no one knows what the best IV fluids are for HG, normal saline and hypertonic saline are common choices. Vitamin and mineral supplements given by IV can be helpful for treating the nutritional deficiencies that can occur with HG.
