GASTROENTEROLOGY ARTICLE OF THE WEEK
November 18, 2010
Niebyl JR. Nausea and vomiting in pregnancy. N Engl J Med 2010;363:1544-50
1. A 28 year old woman with severe nausea and vomiting at 12 weeks of pregnancy is admitted with confusion, lethargy and altered mental status and jaundice. She is afebrile and no prior history is available. Serum ammonia is 45, ALT is 95, drug screen is negative, total bilirubin is 4.5, direct 0.3, INR and platelets are normal, lumbar puncture is negative, brain imaging is normal. You are consulted because of the abnormal liver tests and jaundice. Best immediate course of action is
a. Refer to a liver transplant center
b. Obtain an acute hepatitis panel
c. Get a psychiatric consult
d. Replace thiamine
e. Start ursodeoxycholic acid for intrahepatic cholestasis of pregnancy
True or False
2. Ginger, given in capsule form, may be as effective as vitamin B6 in controlling pregnancy nausea
3. Nausea and vomiting of pregnancy increases the risk of miscarriage.
4. Over 90% of cases of nausea and vomiting of pregnancy resolve by week 12
5. Unisom should not be used to control nausea, as it contains the same compound as bendectin, a teratogen.
6. A high protein diet may help ameliorate some of the nausea of pregnancy
7. Vitamin B6 is more efficacious in patients with low serum levels of B6
8. Ondansetron is as safe as promethazine for use in pregnancy
9. Nausea that persists during the day in pregnancy is usually not due to pregnancy as it is not restricted to the morning
10. A TSH <0.01 in a pregnant patient with nausea and vomiting usually suggests hyperthyroidism as the cause of the GI symptoms.
11. The prevalence of nausea (or nausea and vomiting) and hyperemesis in pregnancy is 50%-75% and <1% respectively
12. B6 for the treatment of nausea has never been shown to be effective on randomized trials.