Principles on the management of severe pregnancy vomiting The first thing to do with severe pregnancy vomiting is to eat, and with fasters, all sorts of problems come up. Few doctors in obstetrics and gynecology are well versed in intravenous nutrition, and fasting + intravenous can stir up even more problems. There is no definitive answer to the question of what causes severe vomiting in pregnancy. Antiemetics have been used safely abroad for many years in the English literature that follows, but I have come across many people who are afraid to use antiemetics other than VB6. The first step in the rehydration of severe pregnancy vomiting is to quickly replenish sugar to address the ketoacidosis caused by albumin catabolism and fat mobilization due to lack of energy and to relieve the burden on the liver. The rehydration should be done until the urine is negative for ketone bodies (at this time, urine sugar can be +++ to ++++). This is the most basic. Next is total fluid replacement and potassium replacement. Judging the patient’s water loss and dehydration by the duration of the disease, weight loss and external manifestations such as skin, replenish the total fluid volume >3000ml per day, paying attention to the sugar and salt mix. As for potassium supplementation, assess the amount already lost + the amount expected to continue to be lost, 4~5g a day is not too much for dramatic patients. In patients with prolonged hyperemesis, the actual systemic loss of water and electrolytes and the consequent need for them, due to organic compensation, far exceeds the deficiencies we estimate from serum indicators. Again, other electrolytes, acid-base balance and vitamins. Note that saline is isotonic but not isotonic (hyperchlorinated), and more balanced salt solutions are recommended. The origin of acidosis is fat mobilization ketone body generation, which will be corrected naturally as long as sugar is replenished. Sodium bicarbonate is rarely needed, otherwise acidosis will be repeated over and over again. “Better acid than alkali” to remove the underlying cause. VB6 is the most basic antiemetic drug for severe pregnancy vomiting. VC, VB1 and other water soluble vitamins are supplemented. Various other tricks and auxiliary medications, ingredients, varieties, types, doses, use more and less, according to each person’s habits love to use how to use, as long as bold enough to dare to ensure safety. Not to use can also be, I suggest not to use, first of all, the benefits are not significant, the second equivalent to increase the variables, not conducive to the judgment of the disease, the third safety is not clear, the fourth I will not use. However, there is one rule: using fatty milk and amino acids in the first place, when the sugar, water and electrolytes are not replenished, will only increase the burden on the liver, aggravate the acidosis and make the condition more severe, and is something that must be strictly prohibited. The laboratory tests for pregnancy vomiting are also simple: urine routine (with emphasis on ketone bodies), electrolytes including K, Na, Ca. For more than one assessment but without qd: liver and kidney function. Those evaluated more than once but not qd: thyroid function. Blood gas analysis is usually not required. A few key points in the assessment and treatment of hyperemesis gravidarum: supplementation = amount already lost + amount continuing to be lost. Energy metabolism (glucose), water metabolism (dehydration dehydration), electrolyte metabolism (K first and foremost), circulatory perfusion (liver damage, renal damage), acid-base balance (ketosis), hyperthyroid state complicated by TSH-like effects of HCG, stress state of persistent hyperemesis. The above relates to risk stratification, pathogenic and organ, metabolic, and molecular concepts. As it relates to the idea of rate, the following bit of knowledge is a few points I took out of the NEJM article. I recommend reading the original article. The translation will be tasteless. These are not just a few numbers, but a theoretical basis and suggestions for directions to understand the disease, grasp the state of affairs, account for the condition, and guide treatment. 50% of pregnant women have vomiting reactions during early pregnancy, and 25% have only nausea. Early pregnancy reactions appear at 4 weeks of menopause and peak at 9 weeks of pregnancy. The percentage of those who have not fully recovered beyond 13 weeks of pregnancy is 40% and beyond 20 weeks of pregnancy is 9%. Thirty-five percent of early pregnancy reactions require clinical intervention. Protective factors for early pregnancy reactions: small placenta, including pregnancies of advanced age, multiple births and smoking pregnant women.