Hyperemesis gravidarum (HG) is the severe form of nausea and vomiting during pregnancy, which can extremely lead to dehydration, significant weight loss, electrolyte and metabolic imbalances. Importantly, early identification of HG symptoms can help to reduce the severity and prevent complications. Although HG is associated with many adverse maternal and fetal outcomes, there is limited understanding about the risk factors. This review provides current data of genetic and maternal factors that are linked to HG. All observational studies published in English that investigated the genetic or maternal factors associated with HG from 2011 until 2021 were systematically searched using PubMed, Scopus, and ProQuest electronic databases. A total of 1462 citation titles was identified, of which 47 potentially relevant abstracts were screened. Of those, 15 studies met the inclusion and exclusion criteria. The genetic variants in ryanodine receptor 2 gene (RYR2), growth differentiation factor-15 gene (GDF15), and protein coding insulin-like growth factor-binding protein 7 (IGFBP7) were found to be associated with HG. On the other hand, several potential maternal factors contributing to the onset of HG were age, Helicobacter pylori infection, body mass index status, a history of HG in a previous pregnancy, high serotonin levels, and reproductive factors. In view of the lack of strength of overall evidence for risk factors related to HG, it is first imperative to establish a precise definition for HG in a diverse study population. Nevertheless, to conclude, this review was able to provide current data of genetic and maternal factors that are associated with HG.
Hyperemesis Gravidarum

Severe hyperemesis gravidarum is a rare but potentially life-threatening it left untreated. Its serious complications are dehydration, ketosis, alkalosis from loss of hydrochloric acid, hypokalemia, and compromised pre-renal acute kidney injury. We experienced a very rare case of a 20-year-old woman who presented to the emergency department with severe hyperemesis gravidarum associated with a loss of kidney function at 25 weeks' gestation. Her initial serum creatinine and blood urea nitrogen were 5.0 and 45.9 mg/dL, respectively. The patient underwent hemodialysis for three days and achieved a subsequent recovery of renal function. In conclusion, our case indicates that clinicians should be aware of the possibility of acute kidney injury associated with severe hyperemesis gravidarum although rare.
Acute Kidney Injury* ; Alkalosis ; Blood Urea Nitrogen ; Creatinine ; Dehydration ; Emergency Service, Hospital ; Female ; Humans ; Hydrochloric Acid ; Hyperemesis Gravidarum* ; Hypokalemia ; Ketosis ; Kidney ; Pregnancy ; Renal Dialysis ; Young Adult

Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
Acute Kidney Injury ; Adult ; Alcohol Drinking ; Ataxia ; Female ; Humans ; Hyperemesis Gravidarum* ; Neurologic Manifestations ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Shock ; Thiamine ; Thiamine Deficiency ; Uterine Hemorrhage ; Wernicke Encephalopathy*

Wernicke's encephalopathy is a reversible but potentially critical disease caused by thiamine deficiency. Most patients complain of symptoms such as ophthalmoplegia, ataxia and confusion. Heavy alcohol drinking is commonly associated with the disease, but other clinical conditions also can provoke it. In pregnant women, hyperemesis gravidarum can lead to the depletion of body thiamine due to poor oral intake and a high metabolic demand. We report a case of Wernicke's encephalopathy following hyperemesis gravidarum in a 36-year-old female at 20 weeks of pregnancy, who visited our hospital because of shock with vaginal bleeding. This case suggests that although the initial presentation may include atypical symptoms (e.g., shock or bleeding), Wernicke's encephalopathy should be considered, and thiamine replacement should be performed in pregnant women with neurologic symptoms and poor oral intake.
Acute Kidney Injury ; Adult ; Alcohol Drinking ; Ataxia ; Female ; Humans ; Hyperemesis Gravidarum ; Neurologic Manifestations ; Ophthalmoplegia ; Pregnancy ; Pregnant Women ; Shock ; Thiamine ; Thiamine Deficiency ; Uterine Hemorrhage ; Wernicke Encephalopathy

Wernicke's encephalopathy is an acute neurological disorder characterized by mental confusion, oculomotor dysfunction, and ataxia. It has been reported in individuals with alcohol dependence, hyperemesis gravidarum, and prolonged parenteral nutrition without vitamin supplementation. Here we present the case of a 13-year-old male patient with neuroblastoma and a history of poor oral intake and nausea for 3 months. After admission, he showed gait disturbances, nystagmus, and excessive dizziness; his mental state, however, indicated he was alert, which did not fit the classical triad of Wernicke's encephalopathy. A diagnosis of Wernicke's encephalopathy was made only after brain magnetic resonance imaging and serum thiamine level analyses were performed. The patient's symptoms remained after 5 days of treatment with 100-mg thiamine once daily; thus, we increased the dosage to 500 mg 3 times daily, 1,500 mg per day. His symptoms then improved after 20 days of replacement therapy. This case report describes a pediatric patient who was promptly diagnosed with Wernicke's encephalopathy, despite only 2 suspicious symptoms, and who completely recovered after high doses of thiamine were given intravenously.
Adolescent ; Alcoholism ; Ataxia ; Brain ; Child* ; Diagnosis ; Dizziness ; Female ; Gait ; Humans ; Hyperemesis Gravidarum ; Magnetic Resonance Imaging ; Male ; Nausea ; Nervous System Diseases ; Neuroblastoma ; Parenteral Nutrition ; Pregnancy ; Thiamine Deficiency ; Thiamine* ; Vitamins ; Wernicke Encephalopathy*

Nausea and vomiting in pregnancy (NVP) is common medical condition during pregnancy and associated with hormonal change. Early recognition and active treatment is warranted because it can be associated with adverse healthy effect in both fetus and mother. First, the possibility of other gastrointestinal disorder should be considered and precipitating factor, renal and liver function should be evaluated. Primay recommended pharmacotherapy is the combination of oral pyridoxine hydrochloride and doxylamine succinate. Other options including dopamin (D2) receptor antagonist, antihistamine and serotonine 5 hydroxytryptamine 3-receptor (5-HT3) can be used. Fluid mixed with multivitamine including thiamine supplement should be considered in case of severe dehydration and hyperemesis gravidarum. Emotional support is also an important part in the management of NVP. The physician shoud apply individualized approach for the safest and most appripriate treatment.
Dehydration ; Doxylamine ; Female ; Fetus ; Humans ; Hyperemesis Gravidarum ; Liver ; Mothers ; Nausea ; Precipitating Factors ; Pregnancy ; Pyridoxine ; Serotonin ; Succinic Acid ; Thiamine ; Vomiting

Acupuncture Points ; Adult ; Female ; Humans ; Hyperemesis Gravidarum ; therapy ; Injections ; Pregnancy ; Thiamine ; administration & dosage ; Young Adult

Nausea and vomiting occur in up to 80% of normal pregnancies. Hyperemesis gravidarum, resulting in dehydration and ketonuria, is a more severe and disabling condition affecting up to 1.5% of pregnancies. This condition is poorly understood and treatment strategies remain largely supportive with the aims of relieving symptoms and preventing complications of the disease. Treatment is supportive with intravenous hydration, antiemetics and correction of vitamin deficiency to minimize complications. There are good data to support the safety and usefulness of some kinds of antiemetics such as antihistamine, phenothiazines metoclopromide and specific HHT3 antagonists in hyperemesis gravidarum. But there is little evidence on which to choose the optimum therapy. This review discusses the diagnosis and management of hyperemesis gravidarum and the prevention, recognition and treatment of the serious complication
Antiemetics ; Avitaminosis ; Dehydration ; Female ; Hyperemesis Gravidarum ; Ketosis ; Nausea ; Phenothiazines ; Pregnancy ; Vomiting

Wernicke's encephalopathy is an acute neurological disorder, caused by thiamine deficiency, which is clinically characterized by a triad of ophthalmoplegia, ataxia and disturbances of consciousness. Most frequently, the encephalopathy is a consequence of chronic alcoholism, but it may occur in other forms of malnutrition or malabsorption, such as in prolonged parenteral nutrition without the addition of thiamine, total gastrectomy, gastrojejunostomy, severe anorexia or hyperemesis gravidarum. Thiamine requirement increases during critical illness and in chronically depleted patients, and its supplementation may influence the outcome of the disease. We report a case of a 73-year-old man, who presented with recurred colon cancer, who was affected by Wernicke's encephalopathy while undergoing oral feeding and parenteral nutrition. This case suggests that we should be more aware of potential thiamine deficiency in critically ill patients, even those undergoing parenteral nutrition and temporary oral feeding.
Aged ; Alcoholism ; Anorexia ; Ataxia ; Colonic Neoplasms ; Consciousness ; Critical Illness ; Female ; Gastrectomy ; Gastric Bypass ; Humans ; Hyperemesis Gravidarum ; Malnutrition ; Nervous System Diseases ; Ophthalmoplegia ; Parenteral Nutrition ; Pregnancy ; Thiamine ; Thiamine Deficiency ; Wernicke Encephalopathy

OBJECTIVETo study the clinical therapeutic effect of integrative Chinese and Western medicine on patients with hyperemesis gravidarum (HG) and its influence on serum level of motilin (MOT).

METHODSSixty patients with HG were randomized equally into two groups, the treated group and the control group. They all received the Western medical supportive treatment mainly by fluid infusion, but for patients in the treated group, Chinese herbal medicine, the Yuntu recipe was given orally in combination. The course of treatment was 6 days. Besides, a group of 30 women with regular pregnancy was set up for normal control. Serum levels of MOT and beta-HCG were measured before and after treatment. And patients were followed up for 2 weeks.

RESULTSThe curative rate and the relapse rate was 73.3% (22/30) and 16.7% (5/25) in the treated group; 56.7% (17/30) and 33.3% (10/20) in the control group respectively, the curative rate was significantly higher and the relapse rate was significantly lower in the treated group than those in the control group (P>0.05). Blood 3-HCG levels in the two HG groups were similar to that of the normal control, and changed insignificantly after treatment (P>0.05), while serum level of MOT in them were 67.15 +/- 15.94 ng/L and 70.28 +/- 13.56 ng/L respectively before treatment, significantly lowers than that of the normal control (145.35 +/- 30.12 ng/L, P<0.05), but it increased significantly after treatment in the treated and the control groups (P<0.05), being 151.50 +/- 54.84 ng/ L vs 103.28 +/- 38.31 ng/L and the increasing in the treated group was more significant than that in the control group (P<0.05).

CONCLUSIONThe occurrence of HG is correlated with the lowering of serum MOT level. Integrative medical treatment is effective in treating HG by way of increasing the serum level of MOT and promoting the peristalsis of stomach.

Adult ; Combined Modality Therapy ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Hyperemesis Gravidarum ; blood ; therapy ; Medicine, Chinese Traditional ; methods ; Motilin ; blood ; Phytotherapy ; Pregnancy ; Young Adult