Children's & Women's Health Centre of British Columbia, Vancouver, British Columbia, Canada
To report our experience in treating hyperemesis gravidarum with nasogastric (NG) tube feeding.
A retrospective look at women admitted to Children's and Women's Health Centre of BC with hyperemesis showed that a 28-year-old woman at 11 weeks' gestation was hospitalized for 54 days for intractable nausea, vomiting, and dehydration. Admission weight was 44.3 kg, down from her usual weight of 50 kg. During her admission, the patient was treated with antiemetic medications, intravenous fluids, and a multivitamin infusion. Oral diet consisted of sips of clear fluids. After 16 days of unsuccessful po diet, a nasogastric tube was inserted, and an iso-osmolar feed was started at 25 mL/h. The rate of infusion was increased gradually in an attempt to meet daily energy requirements as estimated using the Harris-Benedict Equation.
After accounting for losses due to emesis, the energy intake ranged from 24% to 100% of estimated requirements on any given day. This may explain why the patient's weight fell further to 41.5 kg on Day 9 of tube feeding before starting to increase. During this time, nausea and vomiting improved although oral intake remained minimal until Day 33 of the tube feed. As oral intake improved, the rate of feed was then decreased accordingly. On Day 34, oral intake surpassed the tube feed, and the rate was further decreased. By Day 35, the NG tube was removed. Average energy intake for the period of NG feeding was 70% of estimated requirements. The patient was discharged from hospital three days after discontinuation of the tube feed. She weighed 45.6 kg. At 40+ weeks, a healthy girl was delivered, weighing 2,730 g.
Enteral nutrition should be considered as a next step before total parenteral nutrition in hyperemesis gravidarum. It may not be necessary to achieve 100% of estimated energy requirements to promote weight gain in this population.
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