hyperemesis

Do I need Fluids?

Dehydration is one of the first symptoms that a newly pregnant woman may experience indicating that her pregnancy has gone beyond accepted levels of “morning sickness.” As there are no clear alarm bells when this line is crossed, first-time pregnant moms often will become more and more dehydrated, reaching dire conditions, before seeking medical help. For moms with subsequent hyperemesis pregnancies, deciding when to seek IV treatment is an almost constant thought, with the goal of preemptive measures. So, when should you seek medical care for dehydration?

Seeking Care

When women cannot keep down water, the most critical question is, “How do I know if I should seek medical treatment?” Understanding when to seek medical attention is crucial. A doctor told me in my first pregnancy that I should get IV fluids if I’d been vomiting for more than 24 hours. This rule of thumb is simple but not realistic for everyone. The HER Foundation has a list to follow and gives this advice”:

• “If she cannot keep more than a few bites of food or a few sips of water down for 24 hours or more, or loses two or more pounds (0.9 kg) in one week, vomits blood, faints, or generally feels very unwell, call the doctor.
• If she has several of these symptoms after working hours, it may be necessary to go to the ER or an urgent care center.”

Receiving intravenous (IV) fluids is essential under these conditions since the gut will need time to rest after bouts of severe vomiting before attempting to oral intake of fluids.

Measuring Dehydration

How do you measure dehydration? It depends on who you ask! Conventional wisdom says that you’ll have dry lips and concreted urine. Emergency medicine clinicians will look at a combination of results from a urinalysis and a blood panel. Dehydration results in hypovolemia, literally less blood volume, resulting in feeling dizzy from low blood pressure or anxious due to a fast heartbeat. Surprisingly, NIH states that while there is no gold measure, serum osmolality should be checked. Serum osmolality, while incredibly important, is not the first thing an ER provider will measure, if it’s even measured at all. Trust your gut! If you think you are dehydrated, odds are you’re right. If you are in a constant state of thirst, your body is screaming at you that you’ll need a steady prescription of IV rehydration.

Fluid Options

Be sure to keep a record of what types of fluids you receive in your IV, the total quantity, usually in milliliters, and the infusion rate. The most common fluid options include normal saline (NS), half normal saline (1/2 NS), 5% dextrose in water (D5W), and Lactated Ringer’s (LR), which has electrolytes in it. I always recommend LR, but it’s essential to have a blood test done to see which electrolytes need replenishment. If your kidneys are not functioning at a healthy level due to dehydration and you are low in sodium, then normal saline is not the safest option. The infusion rate is also vital because replenishing fluids quickly in dehydrated patients may shift the sodium levels too fast, causing the mom to feel ill instead of relieving the illness.

Beyond Dehydration

If you feel dehydrated and are curious if you’re malnourished too, you can do an at-home urine test to measure the amount of excreted ketones. Ketones show that your body lacks carbohydrates and is using reserves by breaking down fats for energy, a process called ketosis. It’s important to know that having ketones in your urine does not diagnose hyperemesis, as HG is a syndrome and is not determined based on one test. Conversely, if you are denied treatment due to a lack of ketones, educate your medical team on the other signs and symptoms of HG.

Additionally, other diseases, like diabetes, may cause ketones in the urine. While numerous other tests measure nutrition deficiencies, the ketone test is inexpensive, readily available and commonly used at home and in the emergency room.

Addressing Positive Ketone Tests

If you do have high ketones, get proper medical treatment to prevent any harm to the fetus, regardless of whether you have a diagnosis of hyperemesis or not. If a healthcare professional dismisses the need for fluids or denies hyperemesis based on the absence of urinary ketones, it’s essential to communicate your concerns. HG patients with positive ketone tests require intravenous fluids with vitamins to rehydrate, allowing the digestive system to rest and recover.

Dehydration Risks

Dehydration is dangerous in pregnancy in more ways than the obvious. Keep in mind that some medications will not work correctly in a dehydrated state. Many antiemetics dry us out even more, as is the case of medications called anticholinergics. An example is the patch Scopolamine. If the mom is already dehydrated, then taking the medication to stop vomiting may lead to her feeling hot, confused, and constipated, and may eventually lead to heart problems, dilated eyes, confusion and much else. Others, like fiber supplements for constipation, will exacerbate the adverse effects and may lead to severe stomach pain.

Staying vigilant about dehydration and seeking timely medical attention is crucial for a healthy pregnancy. If you ever encounter resistance from healthcare providers, advocating for your well-being is essential.