Initial inpatient fluid management of patients with hyperemesis gravidarum

ECG: electrocardiogram; IV: intravenous; LR: Lactated Ringer solution; mEq: milliequivalents.

* Baseline laboratory tests include serum electrolytes, blood urea nitrogen, creatinine, liver function tests, magnesium, calcium, phosphorus, albumin, and urine ketones and specific gravity.

¶ An IV multivitamin is given daily. We also give additional folic acid to achieve a daily folic acid dose of 1 mg. To mitigate the risk of Wernicke encephalopathy, 100 to 200 mg of thiamine (vitamin B1) should be added to the initial fluid resuscitation and then given daily thereafter while the patient is taking nothing-by-mouth or for 2 to 3 days in patients with oral intake. If Wernicke encephalopathy is suspected, refer to UpToDate content for treatment.

Δ Refer to separate UpToDate algorithm on antiemetic pharmacotherapy of nausea and vomiting of pregnancy.

◊ When a peripheral venous line is used, the usual maximum rate of potassium chloride administration is 10 mEq/hour without cardiac monitoring. When a central venous line is used, the usual maximum rate of administration is 20 mEq/hour with continuous cardiac monitoring.