1. Hyperemesis Gravidarum 妊娠劇吐 –1. 定義： Prolonged and severe nausea/ vomiting associated with dehydration, weight loss, or electrolyte disturbances when pregnancy 。 –2. 發生率： 0.5 – 1.0 of 1000 pregnancies 。

2. 3. 原因： – 不明原因 – 有可能涉及的 Hormonal, neurologic, metabolic, toxic, and psychosocial factors (underlying emotional disorder) – 有相關性的 Degree of biochemical hyperthyroidism The level of beta-HCG

3. 4. Lab 上發現 : –Ketonuria –Increased urine specific gravity –Elevated hematocrit and BUN level –Hyponatremia –Hypokalemia –Hypochloremia –Metabolic alkalosis

4. 5. 檢查： –Urine –Blood (CBC/DC, electrolyte, ABG) –Serum Beta-HCG Molar pregnancy –Thyroid function Hyperthyroidism Transient hyperthyroidism : self-limiting –Resolving by 18 weeks –Sonar

6. 6. 處理： （ Severity of Symptom ） –Indication for hospitalization Intractable emesis Correction of any electrolyte abnormalities Hypovolemia –IV hydration (N/S or D5W) –Anti-emetic drug (ex: Metoclopramide) –Parental nutrition –Electrolyte supplement

7. 6. 處理： –Vitamin supplementation (thiamine – B1) Wernocke’s encephalopathy –Steroid (resistant to conventional treatment) –Oral feedings Slowly when tolerated Starting with clear liquids and progressing to a bland solid diet consisting of small, carbohydrate-rich meals Avoidance of fatty and spicy foods

8. 7. 注意： –Symptoms of hyperemesis persist into 2 nd trimester -> acute peptic ulcer disease from Helicobacter pylori –Pyelonehpritis, red degeneration of myoma, increased intracranial pressure, acute abdominal emergency

9. Thank you for your attention!!