›Consider steroid course after first trimester per obstetric guidance
›Safety considerations
›QT prolongation risk
›Correct electrolytes first
›Avoid multiple QT prolonging agents when possible
Reassessment loop
›Reassessment
›Timing
›Every 30 to 60 minutes initially
›After each medication change
›Targets
›Symptom control allowing oral fluids
›HR improvement
›Urine output improvement
›Repeat labs
›Electrolytes after repletion
›Ketones if severe ketosis
17Disposition/dispo29
Admission criteria
›Admission indications
›Persistent inability to tolerate oral intake
›Ongoing ketonemia or ketonuria with dehydration
›Refractory electrolyte abnormalities
›Potassium not correctable in ED
›Severe hyponatremia
›Acute kidney injury
›Rising creatinine
›Oliguria
›Concern for alternative diagnosis
›Abdominal pathology
›DKA
›Neurologic symptoms
›Wernicke concern
›Severe headache
Observation and discharge criteria
›Observation pathway
›IV fluids and antiemetic response
›Repeat electrolytes acceptable
›Discharge criteria
›Tolerating oral fluids
›Improved symptoms with oral regimen
›Stable vitals
›Reliable follow up
Follow up timing
›Follow up
›Obstetrics
›Within 24 to 72 hours if persistent symptoms
›Routine prenatal follow up if improved
›Primary care
›Within 1 week for medication review
18Discharge Instructions/di25
Copy discharge instructions
›Summary
›Diagnosis
›Dehydration treated with IV fluids
›Medications
›Antiemetic plan
›Scheduled first line medication
›Breakthrough medication
›Prenatal vitamin adjustment
›Consider non iron formulation until improved
›Resume standard formulation when tolerating diet
›Hydration and diet
›Small frequent sips
›Oral rehydration solutions
›Small frequent bland meals
›Return to ED now
›Unable to keep down fluids for 24 hours
›Fainting
›Severe abdominal pain
›Vaginal bleeding
›Fever
›Confusion
›Vision changes
›Follow up
›Obstetric follow up timing
›Medication review timing
19References/r15
Guidelines and key sources
›American College of Obstetricians and Gynecologists
›Practice Bulletin
›Nausea and vomiting of pregnancy
›Royal College of Obstetricians and Gynaecologists
›Green top guideline
›Management of nausea and vomiting of pregnancy and hyperemesis gravidarum
›Society of Obstetric Medicine of Australia and New Zealand
›Guideline statement
›Nausea and vomiting in pregnancy
›UpToDate
›Hyperemesis gravidarum management overview
›Local protocol dependent adaptation
›Cochrane reviews
›Antiemetic effectiveness in nausea and vomiting of pregnancy
›Evidence quality limitations
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.