Hiperemesis gravídica: manejo y consecuencias nutricionales; reporte de caso y revisión de literatura / Hyperemesis gravidarum: management and nutritional implications; case report and review of literature

Introducción: La hiperemesis gravídica es un estado de naúsea y vómito constante durante el embarazo, asociada a deshidratación, trastornos electrolíticos y ácido - base, desnutrición y pérdida de peso (>5%). La prevalencia de la hiperemesis gravídica es del 0.3-2.3% en todos los embarazos. Objetivo: Demostrar la efectividad del soporte nutricional en un caso de Hiperemesis gravídica asociado a desnutrición severa. Se trata de una femenina de 25 años con hiperemesis gravídica, que tuvo pérdida de peso de 17.7%, deshidratación, trastornos electolíticos y arritmias, manejada con nutrición enteral y parenteral en domicilio hasta la semana 26 de gestación logrando cubrir el 70% de sus requerimientos alóricos por vía oral, obteniendo un producto sano y una madre estable nutricionalmente al final del embarazo. Conclusiones: El manejo multidisciplinario y un soporte nutricional especializado en este tipo de casos es imprecindible para llevar al paciente y al producto al final del embarazo en óptimas condiciones (AU)

Introduction: Hyperemesis gravidarum is a state of severe nausea and vomiting during pregnancy, leading to dehydration, electrolyte and acid-base disorders, malnutrition and weight loss (> 5%). The prevalence of hyperemesis gravidarum is 0.3-2.3% of all pregnancies. Objetive: To demonstrate the effectiveness of nutritional support in a case of a complicated hyperemesis gravidarum. A case of a 25 years old woman with hyperemesis gravidarum, who had weight loss of 17.7%, dehydration, electrolyte disorders and arrhythmias, managed with enteral and parenteral nutrition at home until week 26 of gestation reaching to cover 70% of her caloric requirements orally, getting a healthy product and a stable nutritionally mother in late pregnancy. Conclusions: The multidisciplinary management and specialized nutritional management in such cases it is compulsory to carry the patient and the product at the end of pregnancy in optimal conditions (AU)

[Hyperemesis gravidarum: management and nutritional implications; case report and review of literature]. / Hiperemesis gravídica: manejo y consecuencias nutricionales; reporte de caso y revisión de literatura.

INTRODUCTION: Hyperemesis gravidarum is a state of severe nausea and vomiting during pregnancy, leading to dehydration, electrolyte and acid-base disorders, malnutrition and weight loss (> 5%). The prevalence of hyperemesis gravidarum is 0.3-2.3% of all pregnancies. OBJECTIVE: To demonstrate the effectiveness of nutritional support in a case of a complicated hyperemesis gravidarum. A case of a 25 years old woman with hyperemesis gravidarum, who had weight loss of 17.7%, dehydration, electrolyte disorders and arrhythmias, managed with enteral and parenteral nutrition at home until week 26 of gestation reaching to cover 70% of her caloric requirements orally, getting a healthy product and a stable nutritionally mother in late pregnancy. CONCLUSIONS: The multidisciplinary management and specialized nutritional management in such cases it is compulsory to carry the patient and the product at the end of pregnancy in optimal conditions.

Introducción: La hiperemesis gravídica es un estado de naúsea y vómito constante durante el embarazo, asociada a deshidratación, trastornos electrolíticos y ácido ­ base, desnutrición y pérdida de peso (>5%). La prevalencia de la hiperemesis gravídica es del 0.3-2.3% en todos los embarazos. Objetivo: Demostrar la efectividad del soporte nutricional en un caso de Hiperemesis gravídica asociado a desnutrición severa. Se trata de una femenina de 25 años con hiperemesis gravídica, que tuvo pérdida de peso de 17.7%, deshidratación, trastornos electolíticos y arritmias, manejada con nutrición enteral y parenteral en domicilio hasta la semana 26 de gestación logrando cubrir el 70% de sus requerimientos calóricos por vía oral, obteniendo un producto sano y una madre estable nutricionalmente al final del embarazo. Conclusiones: El manejo multidisciplinario y un soporte nutricional especializado en este tipo de casos es imprecindible para llevar al paciente y al producto al final del embarazo en óptimas condiciones.

Parenteral nutrition in the malnourished: dialysis, cancer, obese, and hyperemesis gravidarum patients.

Malnutrition is a complication of many disease processes and can have deleterious effects on patient care outcomes. Providing adequate nutritional support requires a plan that is tailored to the individual needs of the patient and occasionally requires the use of parenteral nutrition. The varied nutritional needs of malnourished dialysis, cancer, obese, and hyperemesis gravidarum patients will be discussed. The infusion nurse specialist is a vital member of the nutrition support team in the care and recovery of the malnourished patient who requires parenteral nutrition.

La gastrostomía endoscópica percutánea. Realidad en la práctica nutricional clínica intra y extrahospitalaria / Percutaneous endoscopic gastrostomy. Reality in the intra- and extra-community clinical nutritional practice

Objetivo. El objetivo de este trabajo ha sido revisar nuestra experiencia durante 8 años de la utilización de la gastrostomía endoscópica percutánea (GEP) y su aplicación en nutrición enteral domiciliaria (NED). Material y métodos. Estudiamos 207 pacientes (56 mujeres y 151 hombres) a los que se le ha realizado GEP desde 1994 al 2002 inclusive, al requerir nutrición enteral de forma prolongada (> 4 semanas). En aquellos casos en los que se programó NED los pacientes/familiares fueron adiestrados en las técnicas y cuidados de la GEP y de la NE, y el control se hizo a través de la consulta externa de Nutrición. Resultados. El tiempo medio de duración de la GEP fue de 640 días y 175 pacientes (84,6%) necesitaron la GEP más de 60 días, mientras que 135 la requirieron más de 6 meses. El aporte calórico medio fue de 1.730 ± 288 Kcal/día; el modo de administración fue mediante infusión intermitente por gravedad en 162 casos y por infusión continua a través de bomba volumétrica en 45 pacientes. En dos pacientes con hiperémesis gravídica se realizó gastroyeyunostomía endoscópica percutánea (GYEP) en el tercer y cuarto mes de embarazo, terminándose con éxito la gestación mediante parto por vía vaginal. La realización de la GEP facilitó el alta hospitalaria y la programación de la NED en 195 pacientes (94%). Las complicaciones más frecuentes fueron la infección de la gastrostomía, que ocurrió en 41 pacientes, y la aparición de granuloma en la ostomía en 34 casos. Sólo hubo un paciente que falleció en relación directa con una peritonitis tras la GEP. Conclusión. De nuestro trabajo se infieren las ventajas de la GEP como técnica de nutrición enteral, permitiendo la instauración de un programa de NED con escasa incidencia de complicaciones y muy baja mortalidad

Background. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortalityBackground. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortalityBackground. This study aimed to review our experience during 8 years in the use of percutaneous endoscopic gastrostomy (PEG) and its application in home enteral nutrition (HEN). Material. We studied 207 patients (56 women and 151 men) who had undergone a PEG from the beginning of 1994 to the end of 2002 as they needed prolonged enteral nutrition (> 4 weeks). In those cases in which home enteral nutrition was programmed, the patients/relatives were trained in the techniques and care of the PEG and EN, and the control was done through the nutrition out-patient clinic. Results. Mean duration time of the PEG was 640 days and 175 patients (84.6%) needed PEG for more than 60 days and 135 for more than 6 months. Mean calorie supply was 1,730 ± 288 Kcal/day. Administration mode was by intermittent infusion due to seriousness in 162 cases and continuous infusion through volemetric pump in 45 patients. In 2 patients with hyperemesis gravidarum, percutaneous endoscopic gastrojejunostomy (PEGJ) was done in the 3rd and 4th month of pregnancy, the pregnancy finishing successfully by vaginal delivery. Performance of PEG facilitated hospital discharge and programming of home enteral nutrition in 195 patients (94%). The most frequent complications were gastrostomy infection that occurred in 41 patients and the appearance of granuloma in the ostomy in 34 cases. Only one patient died in direct relationship due to peritonitis after PEG. Conclusion. Our study includes the advantages of PEG as an enteral nutrition technique, permitting the establishment of a home enteral nutrition program with limited incidence of complications and very low mortality

[Nasoenteral tube feeding in hyperemesis gravidarum. An alternative to parenteral nutrition]. / Nasoenteral sondeernaering ved hyperemesis gravidarum. Et alternativ til parenteral ernaering.

A severe form of hyperemesis gravidarum involving maternal weight loss greater than 5% of the prepregnant weight occurs in up to 0.1-0.2% of all pregnancies and may lead to retarded foetal growth. Treatment consists of hospitalisation, antiemetics and correction of fluid and electrolyte deficiencies. If severe vomiting and weight loss continues, the mother must receive supplementary nutrition, usually parenteral. Nasoenteral tube feeding is a well documented method of nutrition for other patients. A gastroscopically placed nasojejunal tube as part of the treatment of hyperemesis gravidarum has not been reviewed before. Seven women with severe hyperemesis gravidarum were treated with nasojejunal tube feeding. The tube was positioned gastroscopically. Enteral feeding continued for up to 41 days, leading to reasonable weight gain. The tube was tolerated well by most patients and no serious adverse effects were seen. Nasoenteral nutrition ought to be considered as an alternative to parenteral nutrition for treatment of hyperemesis gravidarum.

Nutrición parenteral total en hiperemesis gravídica grave / Total parenteral nutrition in acute hyperemesis gravidarum

La hiperemesis gravídico (HG) grave es una condición poco frecuente asociado al embarazo sin embargo representa un alto riesgo materno-fetal. En estos casos la nutrición parenteral total (NPT) representa una efectiva forma de tratamiento. Se presentan 8 pacientes con HG grave tratados con NPT por vía venosa central. La edad media fue de 27,5 (rango 23 a 36 años), la edad gestacional fluctuó entre las 8-19 semanas (media 15 semanas), y el volumen diario vómito pretratamiento fue de 840 cc (rango 400-1600 cc). Cinco pacientes tenían alteración nutricional calórico-proteica o proteico-visceral con compromiso parcial de la función hepática. Se administró solución glucosada 20-30 por ciento, solución de aminoácidos 8,5 por ciento, emulsión lipídica (3 casos), vitaminas, electrólitos y oligoelementos. El período de NPT hasta la mejoría osciló entre 5-16 días (media=7 días) con un total de 77 días. Los resultados perinatales fueron 7 RN AEG y 1 aborto retenido. Se obtuvo mejoría clínica satisfactoria en todos los casos y no hubo complicaciones

Use of parenteral nutrition to maintain adequate nutritional status in hyperemesis gravidarum.

A retrospective study was performed to demonstrate that safe parenteral nutrition (PN) support can be given during pregnancy. There has been some hesitation to use PN during pregnancy partly due to the unknown consequences of the lipid emulsions in the PN solution. Twenty-three women received PN including lipid daily but at varying stages of pregnancy. The regimen was based on individual calculated requirements plus 300 kcal for pregnancy. Approximately 50% of the nonprotein calories were provided by lipid. At delivery, no gross abnormalities of the placenta were seen. The majority of the women (52%) received PN during the first trimester of pregnancy. The mean duration of PN therapy was 2.7 weeks (SE +/- 0.4) with a range of 0.5 to 7.5 weeks, and the mean weight gain on PN therapy was 2.4 lb (SE +/- 0.5). The majority of the women (84%) were able to gain appropriate weight to maintain the pregnancy. Although there was a 20% incidence of prematurity and a 30% incidence of low birthweight, this was not significantly different from the control group of women matched for age and parity. It was concluded that PN can provide a safe means of maintaining adequate maternal nutrition and continued fetal growth during a period when oral intake is severely curtailed. The nutrition regimen should include lipid and should be customized to meet the specific needs of each individual.

Hyperemesis gravidarum: an approach to the nutritional aspects of care.

There has been little documentation on how to care for the patient with hyperemesis gravidarum. This article presents one method for managing patients with severe hyperemesis gravidarum in the hospital. At MacDonald House of University Hospitals of Cleveland, this method has been used quite successfully for the last five years. The combination of team support, individualized care, supplements created by the dietitian on the basis of patient preferences, and an adapted documented approach for patients with eating aberrations are important aspects of effective management of hyperemesis gravidarum.