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hyperemesis gravidarum [keywords]
- MR Imaging Findings in Alcoholic and Nonalcoholic Acute Wernicke's Encephalopathy: A Review. [REVIEW]
- Biomed Res Int 2014.:503596.
Wernicke's encephalopathy (WE) is a severe neurological syndrome caused by thiamine (vitamin B1) deficiency and clinically characterized by the sudden onset of mental status changes, ocular abnormalities, and ataxia. Apart from chronic alcoholism, the most common cause of WE, a lot of other conditions causing malnutrition and decreasing thiamine absorption such as gastrointestinal surgical procedures and hyperemesis gravidarum must be considered as predisposing factors. Due to its low prevalence and clinical heterogeneity, WE is often misdiagnosed, leading to persistent dysfunctions and, in some cases, to death. Nowadays, MR imaging of the brain, showing T2 and FLAIR hyperintensities in typical (thalami, mammillary bodies, tectal plate, and periaqueductal area) and atypical areas (cerebellum, cranial nerve nuclei, and cerebral cortex), is surely the most important and effective tool in the diagnostic assessment of WE. The aim of this paper is to propose a state of the art of the role of MR imaging in the early diagnosis of this complex disease.
- Hyperparathyroid crisis presenting with hyperemesis gravidarum. [JOURNAL ARTICLE]
- Arch Gynecol Obstet 2014 Jun 11.
Primary hyperparathyroidism during pregnancy is a rare condition, and the diagnosis may be confounded by pregnancy related conditions. Since the appropriate management reduces the maternal and fetal complications; differential diagnosis becomes quite crucial.Clinical course of a patient with hyperparathyroid crisis will be discussed with the review of the literature. A 22-year- old, (gravida 2, para 1) woman was presented with hyperparathyroid crisis at the 11th weeks' gestation. She was hospitalized twice due to hyperemesis gravidarum. When she was admitted to the hospital for the third time due to increased vomiting and weight-loss, serum biochemistry panel was performed and it revealed severe hypercalcemia that serum Ca was 17.59 mg/dl, and she was referred to our hospital as parathyroid crisis. Maternal hypercalcemia was resolved after urgent parathyroidectomy. She was diagnosed as preeclampsia at the 30 weeks' gestation and delivered a male infant weighing 1,090 g at 33 weeks' gestation with APGAR scores 6 at 1 min, and 7 at min 5, without evidence of neonatal hypocalcemia or tetany.Urgent parathyroidectomy is the definite treatment in symptomatic patients with hyperparathyroidism during pregnancy. Resolving maternal hypercalcemia prevents neonatal tetany and hypocalcemia.Hyperemesis may lead to hypercalcemic crisis in patients with hyperparathyroidism, so serum Ca level should be checked in patients with hyperemesis gravidarum especially who detoriate rapidly. Although they share some common pathogenetic mechanisms, there is not enough evidence for attributing preeclampsia to primary hyperparathyroidism.
- PMM.71 Vitamin K deficiency: An under-reported phenomenon in Hyperemesis Gravidarum? [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A145-6.
Hyperemesis gravidarum (HG) is a severe form of nausea and vomiting seen in women during pregnancy and often results in hospital admission.A 33 year old Caucasian woman in her first pregnancy, presented at 13 weeks gestation with a 6 weeks history of significant vomiting and weight loss of 6 kgs. She was admitted as she had not responded to oral antiemetics. During her admission she was managed with parenteral antiemetics, steroids and anti-thrombotics. She was found have a deranged clotting profile but a normal platelet count and liver function tests with no signs or symptoms of bleeding diatheses. The clotting profile was rapidly corrected after parenteral treatment with Vitamin K suggesting a Vitamin K deficiency consequent to hyperemesis.Hyperemesis gravidarum is a serious condition that can result in electrolyte, fluid and nutritional deficiencies. In particular, liver dysfunction has been associated with the condition; however it is not well understood. It should be noted that clotting profile can also be affected by this condition, as seen in this case. Management of HG focuses mainly on rehydration, but it is important to consider and correct nutritional deficiencies and any electrolyte imbalances that may result.Although, there are very few reports of Vitamin K deficiency, it should be taken into consideration, particularly in cases of intractable HG. The severity of nutritional deficiency and weight loss seen in these patients may warrant prophylactic administration of vitamin K to prevent coagulopathy or bleeding diathesis.
- PMM.07 The Hyperemesis Gravidarum Protocol: A retrospective audit of management in a DGH. [Journal Article]
- Arch Dis Child Fetal Neonatal Ed 2014 Jun.:A126.
Hyperemesis gravidarum occurs in less than 1% of pregnancies(1) but causes significant morbidity and burdens inpatient gynaecology services. Best-practice advice is based on expert opinion as no national guidelines on management exist. This audit examined the management of women admitted with hyperemesis against hospital guidelines based on best-evidence expert advice.Women admitted with a diagnosis of 'hyperemesis' over a retrospective 6 month period were identified. Hospital guidelines on hyperemesis management were examined and 62 auditable data points identified. The medical records, discharge summaries, drug charts, and investigations of each admission were studied accordingly.108 admissions over six months were identified, accounting for 291 bed days. Average duration of admission was two days. A significant number of women were re-admitted more than once. Correct admission investigations (15-65%) were often missed. Ward-based monitoring (10-57%) and the provision of advice to patients (2-9%) was poor. Recommended medications were often omitted (12%) or misprescribed (8-43%).Multiple areas of weakness in management were identified. A route-cause analysis was performed and extensive changes to the guidelines were made, patient information leaflets were written and education of the MDT was undertaken as a result. A re-audit was planned to assess the impact of these interventions.Jarvis S, Nelson-Piercy C. Management of nausea and vomiting in pregnancy. BMJ. 2011 Jun 17;342:d3606. doi: 10.1136/bmj.d3606.
- Marked changes in olfactory perception during early pregnancy: a prospective case-control study. [JOURNAL ARTICLE]
- Eur Arch Otorhinolaryngol 2014 Jun 28.
Pregnancy seems to be related with a significant change in olfaction. Here, we investigate this theory by testing the odor identification abilities of uncomplicated pregnant women and compare the results with non-pregnant controls. The study included 31 healthy pregnant women in the first trimester (Group 1), 30 in the second trimester (Group 2), 31 in the third trimester, and 30 non-pregnant healthy controls (Group 4). In order to measure odor identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Next, the demographic characteristics and BSIT scores of the groups were compared. The total BSIT scores of the subjects in Group 1 were found to be significantly lower than those of the other groups (p < 0.001). This reduction in odor identification abilities was particularly noticeable for leather, pine, and soot. Pregnant women in the second and third trimesters had similar odor identification abilities to the healthy controls (p > 0.05). Early pregnancy might be related to significant changes in olfactory performance. The distortion of odor identification in the first trimester might be a causative factor for the development of pregnancy-specific conditions, such as morning sickness and hyperemesis gravidarum, which are both common complaints during the early phase of parturition.
- Hyperemesis Gravidarum is a Syndrome of Metabolic and Endocrine Disturbances: A Case Description. [Journal Article]
- Indian J Clin Biochem 2014 Jul; 29(3):390-2.
Hyperemesis gravidarum is a clinical syndrome characterized by excess vomiting, dehydration and weight loss associated high human chorionic gonadotropin levels, usually occurring in the first trimester of gestation. It often presents with severe electrolyte imbalance, mental confusion and may be associated with thyroid dysfunction. We are describing the management of one such case riddled with multiple metabolic events.
- Unusual presentation of uncommon disease: anorexia nervosa presenting as wernicke-korsakoff syndrome-a case report from southeast Asia. [Journal Article]
- Case Rep Psychiatry 2014.:482136.
Anorexia nervosa presenting as Wernicke-Korsakoff syndrome is rare. The causes of Wernicke-Korsakoff syndrome are multiple like alcohol abuse, thyrotoxicosis, haemodialysis, severe malnutrition because of gastric carcinoma and pyloric obstruction, hyperemesis gravidarum, and prolonged parenteral feeding. We report a case of anorexia nervosa, who presented with Wernicke's encephalopathy and progressed to Korsakoff's syndrome. Knowledge, awareness, and early intervention of anorexia nervosa by mental health professionals can prevent development of Wernicke-Korsakoff syndrome.
- Management of gastrointestinal complaints in differentiated thyroid cancer patients treated with 131I. Comparison of the efficacy of pantoprazole, metoclopramide, and ondansetron - a randomized clinical trial. [JOURNAL ARTICLE]
- Nuklearmedizin 2014 Jun 25; 53(5)
Objective: To compare safety and efficacy of pantoprazol, metoclopramide, ondansetron, as compared to placebo, in controlling gastrointestinal (GI) complaints of thyroid cancer patients treated with I-131these patients. Design: Four-armed, parallel group, single blind, randomized controlled clinical trial, setting: A university hospital, registration: database for clinical trials IRCT2013061713705N1. Patients: 85 patients with differentiated thyroid cancer who received 131I. Main outcome measures: Postradioiodine nausea and vomiting within three days of therapy (primary endpoint); occurrence of adverse reaction. Results: The patients' characteristics were similar within the study groups. Among the study variables, age, sex, administered dosage, history of previous GI complaints, and history of hyperemesis gravidarum in female patients were not statistically different among the groups (p > 0.05). The results revealed that only ondansetron shows a therapeutic benefit over the placebo in controlling nausea (p < 0.05); however, it does not prevent vomiting (p > 0.05). The other two drugs, pantoprazole and metoclopramide, did not control nausea (p > 0.05) or vomiting (p > 0.05). Conclusions: This study may demonstrate that the therapeutic dose of ondansetron could be an effective prophylactic agent in controlling GI complaints in differential thyroid carcinoma (DTC) patients following RAI therapy; however, these preliminary findings should be validated in larger studies.
- Postural balance in pregnancies complicated by hyperemesis gravidarum. [JOURNAL ARTICLE]
- J Matern Fetal Neonatal Med 2014 Jun 12.:1-14.
Abstract Objective: To assess postural balance in females with pregnancies complicated by hyperemesis gravidarum (HG). Methods: In this observational study, postural balance during the first trimester was measured using the Biodex Balance System (BBS) in 41 pregnant females (20 females with pregnancies complicated by HG and 21 healthy controls). The overall stability index (OA), anterior-posterior stability index (APSI), medial-lateral stability index (MLSI) and fall risk test (FRT) scores were obtained from the mean scores of three trials on the BSS. The four measurements obtained from the BBS (OA, APSI, MLSI and FRT) were compared between healthy pregnant females and those with pregnancies complicated by HG (HG group). Results: The mean OA and APSI scores were significantly higher in the HG group compared to healthy pregnant controls (p<0.01). There was no significant difference in the MLSI between the two groups (p>0.05). The FRT scores of HG patients were higher than healthy pregnant females (p=0.001). Conclusions: Pregnant females with HG have poor postural stability/balance and high fall risk test scores. HG causes decreased postural equilibrium in the first trimester of pregnancy.
- Direct Analysis of hCGβcf Glycosylation in Normal and Aberrant Pregnancy by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry. [JOURNAL ARTICLE]
- Int J Mol Sci 2014; 15(6):10067-10082.
The analysis of human chorionic gonadotropin (hCG) in clinical chemistry laboratories by specific immunoassay is well established. However, changes in glycosylation are not as easily assayed and yet alterations in hCG glycosylation is associated with abnormal pregnancy. hCGβ-core fragment (hCGβcf) was isolated from the urine of women, pregnant with normal, molar and hyperemesis gravidarum pregnancies. Each sample was subjected to matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI TOF MS) analysis following dithiothreitol (DTT) reduction and fingerprint spectra of peptide hCGβ 6-40 were analyzed. Samples were variably glycosylated, where most structures were small, core and largely mono-antennary. Larger single bi-antennary and mixtures of larger mono-antennary and bi-antennary moieties were also observed in some samples. Larger glycoforms were more abundant in the abnormal pregnancies and tri-antennary carbohydrate moieties were only observed in the samples from molar and hyperemesis gravidarum pregnancies. Given that such spectral profiling differences may be characteristic, development of small sample preparation for mass spectral analysis of hCG may lead to a simpler and faster approach to glycostructural analysis and potentially a novel clinical diagnostic test.