HIPEREMESIS GRAVIDARUM

Definitions
Hiperemesis gravidarum is excessive vomiting occur until the age
22 sunday pregnancy. Vomiting can be so great is all that is eaten
and drink again.
Causes
It is not yet known. Some of the causes of the theory:
1. Increased estrogen
2. Increased hormone Human Chorionic Gonadotropin (HCG)
3. Disfungsi psychic
Clinical picture
The clinical hiperemesis gravidarum divided into 3 levels, namely:
1. Level I
- Vomiting is ongoing, relief food and intolerance against
drinks, body weight decreased, epigastrium pain, vomiting first exit
food, mucus and bile and only a little phlegm, bile fluid
and the last blood out.
- Nadi increased to 100 times per minute and blood pressure sistole
decreased.
- Deep-set eyes and dry tongue, decreased skin turgor and still urin
normal.
2. Level II
- More serious symptoims, vomiting all that is eaten and drunk , thirsty
great,
- Subfebril, rapid pulse and more 100 - 140 times per minute, blood pressure
sistole less than 80 mmHg,
- Apathetic, pale skin, tongue, dirty, sometimes ikterus there, there aseton, bilirubin
and body-weight rapidly decreased.
3. Level III
- Disturbances awareness (delirium, coma), a decrease or stop vomiting,
ikterus, sianosis, nistagmus, heart disturbances, and bilirubin
proteinuria.

Diagnosis
1. Amenore with the severe vomiting (all that will be eaten and drunk
dimuntahkan), daily work disrupted and thirsty.
2. Vital functions: increased pulse 100 times per minute, blood pressure decreased on
the weight, interference and subfebril awareness (apathetic-comma).
3. Physical examination: dehydration, the weight, pale skin, ikterus, sianosis,
body weight decreased, porsio software on vaginal Touche, according to large uterus
gestasi age.
4. Laboratory: relative increase in hemoglobin and hematokrit, shift to the left,
keton objects and proteinuria.
Treatment
1. Diet
a. Diet hiperemesis I hiperemesis given the level III. Food only
the form of bread and dried fruits. Not provided with liquid
food, but after 1-2 hours. Food is less oxygen in the oxygen -
nutrients except vitamin C because it provided only for a few days.
b. Diet hiperemesis II when given a sense reduced nausea and vomiting. The
gradually start given food nutrition value is high.
Drink not provided with food. This food is low in
all substances-vitamins except vitamin A and D.
c. Diet hiperemesis III is given to patients with mild hiperemesis.
According to the ability of beverages can be supplied with
food. Food in all of this enough vitamin except calcium.
2. In the case of:
- Stop eating / drinking while per oral (24 - 48 hours).
- Infus dextrose 5% or 10%: RL = 2: 1, 40 drops per minute.
- Drugs:
§ iv Vitamin B: Vitamin B1, B2 and B6 each 50 - 100
mg / day / infus, Vitamin B12 and 200 mcg / hr / infus,
§ Penenang minor: Fenobarbital 30 mg im 2 - 3 times per day or
Klorpromazin 25 - 50 mg per day, or diazepam 5 mg 2 - 3 times per day
i.m.
§ Antiemetik: prometazin 2 - 3 times 25 mg per day or klorpromazin
3 mg 3 times per day
§ Antasida 3 x 1 tab per day per oral
- Consider referred to the hospital.