Health Questions and Answers

Question: How should nausea and vomiting/hyperemesis be managed?


The mainstay of treatment is symptomatic therapy with close attention to fluid balance. Frequent small meals and avoidance of aggravating food sources are important. Ginger tea is a much touted anecdotal remedy, and powdered ginger has been proven effective when studied clinically. A randomized clinical trial of vitamin B6 versus placebo proved its efficacy in patients taking 30 mg of pyridoxine daily. Recent studies looking at acupressure bands and transcutaneous nerve stimulation have shown some efficacy.
Antiemetics are indicated for intractable symptoms despite adequate hydration: metoclopromide (Reglan), phenothiazines, and ondansetron (Zofran) are effective, and appear to be safe in pregnancy. Systemic steroids are an additional therapy of interest for patients who fail antiemetics; a randomized controlled trial of 40 patients comparing oral methylprednisolone to oral promethazine demonstrated a superior response to steroids, as no patients in the methylprednisolone group required readmission, compared to 5 of 17 in the promethazine group. No adverse fetal effects have been described with this treatment.
Finally, total parenteral nutrition is merited for patients who cannot sustain their weight and have persistent vomiting despite therapy.

Reference: Safari HR, Fassett MJ, Souter IC, et al: The efficacy of methylprednisolone in the treatment of hyperemesis gravidarum: A randomized, double blind controlled study. Am J Obstet Gynecol 179:921-924, 1998. Medline Similar articles

2 Responses to “Question: How should nausea and vomiting/hyperemesis be managed?”

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