Hyperemesis Gravidarum (HG) (Severe morning sickness) symptoms and treatment

One to three percent of pregnant women suffer from an EXCESSIVE amount of nausea and vomiting that interfere with nutrition and hydration.   You should consult a qualified medical professional if you are vomiting more than three times a day, are unable to retain any fluids you drink, and are progressively losing weight. HG can be devastating for the mother and detrimental to the baby when the mother is unable to keep anything down and has to be hospitalized for intravenous feeding.

Check your own symptoms against this list as a general indication:

• Severe and persistent vomiting

•  Dehydration - signs of dehydration listed below:

Ketones in urine (easy to test yourself with Ketostix - available online)

Decreased blood pressure

Increased heart rate

Pinched skin returns slowly.

Flushed dry skin

Dry eyes

Dry Mouth

Coated tongue

Trouble thinking clearly/confusion

Decreased urination

Dark urine

•  Loss of weight (anything over 5% of your pre-pregnancy weight)

•  Tachycardia (rapid heartbeat)

•  Constipation

•  Difficulty eating and drinking

•  Extreme fatigue

•  Nausea aggravated by physical temperature extremes

•  Increase in saliva resulting in difficult swallowing

•  Slow or inpaired thinking

•  Decrease in attentionspan

•  Blood electrolyte levels abnormal

•  Decreased Motivation

•  Decreased physical performance

•  Increased anxiety

•  Symptoms aggravated by motions

•  Poor skin tone

•  Dry, shrunken tongue

•  Need for intravenous nutrition

•  Aching eyeballs, difficulty focusing, rapid vision changes

•  Boredom

Evidence suggests that the hormone LEPTIN plays a role in severe morning sickness (and PCOS)

Aka N, Atalay S et al, (2006). "Leptin and leptin receptor levels in pregnant women with hyperemesis gravidarum". The Australian & New Zealand journal of obstetrics & gynaecology 46 (4): 274-7;

"Cervero A et al, (2006), The role of the leptin in reproduction". Curr. Opin. Obstet. Gynecol. 18 (3): 297-303.

Zofran for HG?

Used for HG, many women have found prescription Zofran (Ondansetron hydrochloride) effective at helping them stay nourished and hydrated

•  Zofran is an antiemetic - effective at stopping nausea and vomiting;

•  Zofran works by blocking the hormone SEROTONIN - which causes vomiting.

Selective serotonin-3 (5HT-3) antagonist.   5HT-3 receptors are mainly found in the small intestine (and in the CNS to a lesser degree). By blocking this receptor you decrease the nausea. The 5HT-3 receptor is responsible for the nausea (seen as a start-up side effect of the SSRIs). Stimulation of the 5HT-3 receptor by the increased serotonin (as a result of the SSRI) causes nausea, which is resolved when this receptor is desensitized (usually within the first month after starting the SSRI).

Zofran Safety?

The FDA labels Zofran as a category B.     given to medicines that have NOT been studied in pregnant humans, but do not appear to cause harm to the fetus in animal studies.

There are no adequate and well-controlled studies in pregnant women - and so this drug should be used during pregnancy only if clearly needed. Studies on pregnant rats and rabbits given Zofran have revealed no evidence of impaired fertility or harm to the fetus.

Possible Side Effects of Zofran

(official Zofran site: http://us.gsk.com/products/assets/us_zofran_tablets.pdf)

•  Headache

•  Diarrhea

•  Constipation

•  Fever

•  Malaise/fatigue

•  Lightheadedness

•  Drowsiness

Precautions for Taking Zofran

Do not drive while taking Zofran

A history of any of the following problems may affect your being able to take Zofran

•  Stomach/intestinal problems

•  Liver disease

•  Allergies

Save Money BY Buying Generic Zofran

Zofran (Ondansetron hydrochloride) is very expensive (~$900 for 30 tablets).   Many insurance companies will not cover the cost of Zofran. Ask your doctor for the generic brand of ondansetron, which is much cheaper.

Alternative Drugs for Nausea

Emitrol (no prescription needed)

Bendectin.    A combination of Vitamin B6 (pyridoxine) and an antihistamine, doxylamine(antihistamines calm the labyrinthine inner ear); Available in Canada as Dicletin or you can buy the ingredients separately and combine them); FDA declared "Safe and effective for nausea and vomiting of pregnancy."Compazine (Prochlorperazine) and Phenergan (Promethazine) - these are phenothiazine-like drugs, meaning they act centrally in the brain to relieve nausea. Technically, they're sedative-antihistamines, like the doxylamine in Bendectin.