![]() Today, The Guardian relayed one of those stunning medical stories that causes me to clean off my glasses and take another look to make sure I’m reading it clearly. Treatment and outcome of nausea and vomiting of pregnancy. Literature review current through. May 2. 01. 7. Severe vomiting resulting in dehydration and weight loss is termed hyperemesis gravidarum and occurs infrequently. Symptoms usually resolve by midpregnancy regardless of severity and therapy. Management of women with nausea and vomiting of pregnancy depends upon symptom severity, the impact of her symptoms on her health and quality of life, and the safety of treatment for both her and the fetus. Treatment approaches include dietary/lifestyle changes, medication, and hospitalization for parenteral fluids and therapies in women with dehydration who fail to respond to outpatient management. Enteral or parenteral nutrition may be required for women with persistent weight loss despite these interventions. The treatment and outcome of nausea and vomiting of pregnancy will be reviewed here. The pathophysiology, clinical features, and evaluation of this disorder are discussed separately. These designations refer to the woman's primary problem and are somewhat arbitrary as the frequency of vomiting typically varies from day to day. Ginger and/or pyridoxine or doxylamine- pyridoxine is added if symptoms do not improve (algorithm 1). Diet. Meals and snacks — Women with nausea should eat before, or as soon as, they feel hungry to avoid an empty stomach, which can aggravate nausea . A snack before getting out of bed in the morning and snacks during the night (eg, crackers with peanut butter or cheese taken prior to bathroom trips) may be helpful. ![]() ![]() Meals and snacks should be eaten slowly and in small amounts every one to two hours to avoid a full stomach, which can also aggravate nausea . Dietary manipulations that help some women include eliminating coffee and spicy, odorous, high- fat, acidic, and very sweet foods, and substituting snacks/meals that are protein- dominant, salty, low- fat, bland, and/or dry (eg, nuts, pretzels, crackers, cereal, toast) . Drinking peppermint tea or sucking peppermint candies may reduce postprandial nausea . However, high- quality evidence of the optimal dietary components to reduce nausea are sparse. Although clinicians commonly recommend ingestion of frequent, small, carbohydrate- predominant meals/snacks, such as soda crackers or dry toast, based primarily on anecdotal evidence passed down over a century . ![]() ![]() Fluids are better tolerated if cold, clear, and carbonated or sour (eg, ginger ale, lemonade, popsicles) and taken in small amounts; using a straw sometimes helps . Some women find aromatic liquids, such as lemon or mint tea, more tolerable. Small volumes of electrolyte- replacement sports drinks can be used to replace both fluids and electrolytes, if tolerated. Avoidance of triggers — Along with dietary changes, avoidance of environmental triggers is a key intervention for reducing nausea and vomiting of pregnancy . Examples of some triggers include stuffy rooms, odors (eg, perfume, chemicals, food, smoke) . Quickly changing position and not getting enough rest, particularly after eating, may also aggravate symptoms . Lying down soon after eating and lying on the left side are additional potentially aggravating factors because these actions may delay gastric emptying . How to Cure Diarrhea. Diarrhea is not a condition: it is a symptom of another health issue, such as an infection or a virus. It can also be a reaction to food. Cold solid foods are tolerated better than hot solid foods because they have less odor and require less preparation time (ie, shorter exposure to the trigger if the woman is preparing her own meal) . Brushing teeth after a meal . Taking prenatal vitamins before bed with a snack, instead of in the morning or on an empty stomach, may also be helpful . We do not prescribe powdered ginger because standard pharmacologic- grade ginger preparations are not readily available . In a 2. 01. 4 systematic review and meta- analysis of 1. How to Cope with a Stomach Flu. The stomach flu, medically known as Gastroenteritis, can leave you sick for several days at a time. Although most often not fatal.![]() Sensory neuropathy has been reported with chronic intake of pyridoxine at doses > 5. Human data on fetal safety at this dose are limited. ![]() An observational study of 9. Pyridoxine 1. 00 mg/kg was not teratogenic in animal studies . The mechanism for the therapeutic effect is unknown. Hypotheses include prevention/treatment of vitamin B6 deficiency, intrinsic antinausea properties, and/or synergy with the antinausea properties of antihistamines . Although vitamin B6 levels decrease as gestation advances, there is no proven correlation between maternal vitamin B6 levels and incidence or severity of nausea . Formulations of doxylamine- pyridoxine are available under various names worldwide (eg, Diclectin in Canada, Diclegis and Bonjesta in the United States). Initially, we prescribe two extended- release tablets (each tablet contains doxylamine 1. The dose may be increased to four tablets over the course of the day as needed for more severe nausea (one tablet in the morning, one tablet in the afternoon, two tablets at bedtime). An extended- release tablet containing 2. Two parts of the BRAT diet: bananas and toast. All you need is applesauce and rice to round it out. Ellie Wells / EyeEm / Getty Images. Stomach Flu Facts Every Parent Should Know. March 17, 2008. 1,119,160 views. What to Do If Your Child Has Diarrhea. You are playing happily with your baby when you suddenly detect a rather unpleasant odor emanating from the diaper area. The BRAT diet is a diet that health care practitioners recommend for individuals who have an upset stomach, nausea, vomiting, or gastroenteritis. They other type of. BRAT Diet Precautions. If the BRAT diet or other foods for diarrhea don’t work after four to five days (two days for an infant or child), it’s time to see your. 1,25-dihydroxycholecalciferol,calcitriol,rocaltrol,calcijex,25-hydroxycholecalciferol,calcifediol,ergocalciferol,vitamin d2,calderol,calciferol,drisdol,ostoforte. ![]() A randomized placebo- controlled trial found that doxylamine succinate 1. In the United States, doxylamine is available in some over- the- counter sleeping pills (eg, Unisom Sleep Tabs) and as a prescription antihistamine chewable tablet (eg, Aldex AN): One- half of the 2. In addition, pyridoxine 2. United States. This is a reasonable, less expensive substitute for combination tablets. Doxylamine- pyridoxine was proven modestly effective for treatment of nausea and vomiting of pregnancy in a meta- analysis of placebo- controlled randomized trials . It was the formulation for Bendectin, which was voluntarily withdrawn from the market in 1. A meta- analysis of controlled studies on outcome of pregnancies exposed to Bendectin reported no increase in the incidence of birth defects . In a 2. 01. 5 systematic review of randomized trials of interventions for nausea and vomiting in early pregnancy, an acupressure wristband or P6 acupuncture was not significantly more effective than placebo . One reason may be that a strong placebo effect has been observed in patients who receive sham therapy . Acupressure and acupuncture have not been associated with any adverse effects on pregnancy outcome and may help some women, even if a placebo effect. Self- administered nerve stimulation therapy over the volar aspect of the wrist at the P6 acupressure point using a commercial device also showed some promise in two randomized trials . As an example, in 2. US Food and Drug Administration notified health care professionals and pregnant or breastfeeding women to avoid consuming Nzu, a traditional African remedy for morning sickness, because of potential health risks from high levels of lead and arsenic, a problem that has been reported by others . Nzu may be sold under such names as Calabash clay, Calabar stone, Mabele, Argile, or La Craie. ![]() If the initial drug is ineffective, then other drugs are added in a step- wise progression (algorithm 1) . We typically continue a drug for a week to determine whether nausea and vomiting are improving. If symptoms persist, then we add another class of drug to the existing regimen; however, if the patient is experiencing side effects, we substitute another drug in its place. Women who are vomiting most food and liquids require frequent, even daily, assessment of their medical status and response to therapy. Those who are becoming dehydrated are admitted for hour to hour evaluation and more intensive therapy. Thus, there are limited data from pregnant women to support the safety and efficacy of drugs used to treat nausea and vomiting. A number of reports have demonstrated that antiemetic drug therapy is more effective than placebo and does not increase the incidence of congenital anomalies . However, there is little evidence from well- designed comparative trials upon which to base a treatment plan for women with nausea and vomiting of pregnancy. Secondary drugs. Antihistamines (H1 antagonists) — If doxylamine and pyridoxine (see 'Doxylamine succinate and pyridoxine' above) has been ineffective, it should be discontinued before starting a different antihistamine. We suggest the following antihistamines as second- line agents for women who are vomiting. We begin with these drugs because they either have fewer maternal side effects or a more established fetal safety profile compared with other drugs. Dimenhydrinate, meclizine, and diphenhydramine are the antihistamines that have been most extensively studied for treatment of nausea and vomiting of pregnancy. There are no data on use of the scopolamine patch for nausea and vomiting of pregnancy. The efficacy of antihistamines was illustrated in an analysis of pooled data from controlled trials that found use of these agents significantly reduced pregnancy- related nausea and vomiting (relative risk . This review of 2. H1 receptor blockers appeared to have a protective effect on risk of malformations (odds ratio . Subsequent reviews have confirmed these findings . In addition, these agents inhibit the muscarinic receptor, which may mediate the emetic response. Common side effects of this class of drugs include sedation, dry mouth, lightheadedness, and constipation. Diphenhydramine — Diphenhydramine 2. It can also be given intravenously 1. Diphenhydramine is commonly used in pregnancy for treatment of nausea and vomiting as well as allergy symptoms (rhinitis, pruritus) and insomnia; available safety data are generally reassuring that it is not a teratogen . Meclizine has caused cleft palate in rats but at exposures far higher than those used therapeutically. Human data of an association between facial clefts and meclizine have been mixed, but three large studies did not show an increased risk of malformations . Otherwise, 5. 0 mg dimenhydrinate is administered intravenously over 2. If the woman has recently taken doxylamine, the total dose of dimenhydrinate should not exceed 2. Available safety data are generally reassuring that it is not a teratogen . The three main classes are benzamides (metoclopramide), phenothiazines (promethazine and prochlorperazine), and butyrophenones (droperidol).
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. Archives
November 2017
Categories |