Hyperemesis gravidarum: implications for home care and infusion therapies

Nausea and vomiting afflicts up to 80% of pregnancies, with the more severe form, hyperemesis, complicating about 1%. Hyperemesis in pregnancy causes fluid volume deficit, starvational ketoacidosis, and at times, metabolic alkalosis with hypokalemia. Significant weight loss may occur and reflect fluid as well as lean tissue loss. The cause is unknown, and although prognosis is generally good with aggressive fluid replacement and nutritional support, there is potential for decreased birth weight. Management strategies for hyperemesis gravidarum, including hydration, enteral and parenteral nutrition, antiemetic therapies, monitoring needs, and psychosocial concerns are discussed with applications made to the home care setting.