Concluded Case

Hyperemesis Gravidarum

A 4 months primigravida of age 26yr suffering from:- 1) 1-3 Vomiting per day On & Off since 2M 2) Dizziness over a whole day 3) Feeling Not fresh. On Medication:- 1) Inj. Hydrooxyprogesteron 500mg per week 2) Doxylamine succinate 20mg OD 3) Ecosprin 75 mg OD 4) Iron and other supplement Past H/O:- 1) PCOD since last 3 yr 2) No H/O DM , HTN, Thyroid. Current Investigation:- 1) CBC , RBS, TFT are WNL 2) Neonatal Scan :- Attached On Examination:- BP :- 90/60 mmHg PP:- 76/min SpO2:- 98% Pls suggest your valuable opinion and mangemant

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Concluded answer

It is a case of Primigravida at 4 months of pregnancy with vomiting on and off. Usg is within normal limit. She should be advised for urine ketone. She can be admitted in day care for intravenous hydration with normal saline, ringer lactate and glucose. Onit Hydroxy progesterone caproate unless now specifically indiictated. Light regular simple diet . Put her on dicyclomine thrice daily alongwith rabiperazole 40 mg daily. Preferably onit iron supplementation till vomiting stops unless specifically needed in which case parenterally can be given. Put on mild tranquilliser after lunch and dinner for a week. To drink plenty of fluid daily (4 lit).

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It is a case of Primigravida at 4 months of pregnancy with vomiting on and off. Usg is within normal limit. She should be advised for urine ketone. She can be admitted in day care for intravenous hydration with normal saline, ringer lactate and glucose. Onit Hydroxy progesterone caproate unless now specifically indiictated. Light regular simple diet . Put her on dicyclomine thrice daily alongwith rabiperazole 40 mg daily. Preferably onit iron supplementation till vomiting stops unless specifically needed in which case parenterally can be given. Put on mild tranquilliser after lunch and dinner for a week. To drink plenty of fluid daily (4 lit).

Thanks sir for your valuable opinion.
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1-3 episode of vomiting, on and off. Advice adequate fluid intake. Dizziness is sign of dehydration. Day care admission for IV fluids. Advice urine routine and microscopic. Look for ketone bodies. Inj multivitamin. USG is fine. Placenta will migrate. Iron supplements does cause nausea and hyperacidity in some patients. you can omit it till the symptoms subside. Rest, continue the same treatment. Adv Anomaly scan at 19weeks

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IT'S A..CASE OF.. HYPEREMESIS GRAVIDENUM.. WITH.. HYPOTENSION..BP..90/60 mm Hg NEED'S.. IV FLUIDS.. PPI.. GRANICETRONE.. POLYBION.. REST.. CT.. ALL. . EXPERTS OPINION..

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Placenta low lying, so carry on Hydeoxyprogesterone 500mg weekly Start with Doxylamine 10mg bd Rab dsr od Ondem bd Folic acid od Stop iron supplement for few days,

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Should avoid iron supplements and advice to take plenty of water and electrolytes, otherwise finding and treatment is adequate in my opinion

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Give iv frutodex in water 1000 ml 3 days Give sweet in morning on leaving bed Antacid, folic acid and antiemetic bd to be given

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POSSIBLY SECONDARY. TO IRON. SUPPLEMENTS

garbhpal ras + pravalpisthi

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