Enteral nutrition by nasojejunal tube in hyperemesis gravidarum

We describe two cases in which self-propelling, blind placed nasojejunal tubes were placed in severe hyperemesis gravidarum. This method provides an alternative to parenteral nutrition and to percutaneous endoscopic tubes, is well tolerated, cost effective and with a low rate of complication. Both mothers were given nutritional support at home, had normal subsequent pregnancies and normal babies.     

Enteral nutrition in hyperemesis gravidarum: a new development.

Hyperemesis gravidarum occurs in up to 2% of pregnancies. Hospitalization is commonly required to treat dehydration and electrolyte and metabolic imbalances. Severe forms of hyperemesis gravidarum involving weight loss greater than 5% of prepregnancy weight have been associated with poor fetal growth and outcome. Hyperemesis gravidarum is a high-risk condition from a nutritional perspective. Traditional approaches to nutrition management focus on the cautious introduction of fluids and low-fat solids following resolution of acute nausea and vomiting. When trials of oral feeding fail to be tolerated, consideration should be given to the enteral route as the means of nutritional rehabilitation. A carefully designed delivery regimen combined with antiemetic therapy can prevent abdominal or sensory episodes that might precipitate further vomiting. Two case studies of the successful use of enteral nutrition in hyperemesis gravidarum are presented. Although clinical experience is limited and further research is needed, early results suggest that enteral nutrition in hyperemesis gravidarum is an effective and safe technique.     

A severe case of hyperemesis gravidarum necessitating prolonged total parenteral nutrition

A patient with severe hyperemesis gravidarum persisting throughout pregnancy is described. She had marked abnormalities of liver function and failed to respond to conservative management. Total parenteral nutrition was used to maintain her nutritional status as well as that of the foetus. Her vomiting continued and was complicated by severe oesophagitis. On delivery her symptoms settled, but she later developed an oesophageal stricture. Changes in liver function tests are described.     

短肽型肠内营养制剂治疗乳糜性胸水

目的:观察在乳糜性胸水病人早期应用短肽型肠内营养(EN)制剂对疾病转归的影响。方法:对17例确诊为乳糜性胸水的病人早期应用短肽型EN制剂作为保守治疗的主要措施。结果:15例病人经2周保守治疗后治愈,2例保守治疗无效经手术治疗后治愈。结论:早期应用短肽型EN制剂能改善乳糜性胸水保守治疗的疗效和改善病人的营养状态。     

家庭肠内营养支持的应用

目的:研究分析近3年来家庭肠内营养(HEN)支持的应用情况及经验. 方法:回顾性分析2001年12月至2004年11月HEN病人资料,重点研究HEN的适应证、使用途径、输注方法、制剂种类、使用时间、并发症及处理. 结果:HEN病人共111例,HEN适应证有56.8%是恶性肿瘤病人,57.6%通过经皮内镜下胃或空肠造口途径,循环输注是主要方法(56.8%),使用商品化EN制剂联合自制匀浆最为广泛(79.3%),大多为自费(71.2%).HEN并发症轻微,易控制. 结论:HEN操作简便,安全有效,是目前主要应用形式.     

Enteral nutrition by percutaneous endoscopic gastrojejunostomy in severe hyperemesis gravidarum: a report of two cases

We describe the first two cases in which percutaneous endoscopic gastrojejunostomy was used as a means to provide enteral nutrition in severe hypermesis gravidarum. The use of this method of enteral access provided an alternative to parenteral nutrition, was well tolerated, cost-effective and had no major complications. In both cases the nutritional goal for mothers as well as appropriate fetal growth and development were achieved.     

Hyperamylasemia in bulimia nervosa and hyperemesis gravidarum.

OBJECTIVES: The exact causes of hyperamylasemia detected in bulimia nervosa are unknown but it is presumed to be due either to repeated binging or to vomiting. This study set out to investigate the importance of vomiting in producing the raised serum amylase and to clarify whether the amylase in pancreatic or salivary. METHODS: Patients suffering from hyperemesis gravidarum who were repeatedly vomiting in pregnancy but not binge eating had their total serum and pancreatic amylase measured. Bulimic patients and a control sample of nonvomiting pregnant women were similarly studied. An assessment of the frequency and duration of vomiting and binging was also made. RESULTS: Results show 45% (5) of bulimic patients had raised serum amylase, but none had a raised pancreatic amylase. Twenty-four percent (7) of the hyperemetic patients also had a raised serum amylase level, all with a normal pancreatic amylase level. None of the nonvomiting pregnant patients had a raised amylase. DISCUSSION: Of patients with hyperemesis gravidarum who repeatedly vomit but do not binge, a significant number had raised amylase. This suggests that it is the vomiting rather than the binge behavior that increases amylase in bulimic patients. This increased amylase probably comes from the salivary gland.     

Thiamine deficiency and beriberi features in a patient with hyperemesis gravidarum

Wernicke's encephalopathy has been sporadically reported in patients with severe hyperemesis gravidarum. We report a new case of Wernicke's encephalopathy in a patient who had hyperemesis gravidarum associated with signs and symptoms of dry and wet beriberi. The case was managed with very large doses of thiamine. The conclusion was that, in long-lasting hyperemesis gravidarum, recognizing signs of beriberi may help prevent the onset of Wernicke's encephalopathy, thanks to timely therapy with thiamine supplements. A thiamine therapy similar to the one reported in this article could prove useful in long-lasting hyperemesis gravidarum complicated by Wernicke's encephalopathy.     

Diet before pregnancy and the risk of hyperemesis gravidarum

Hyperemesis gravidarum (hyperemesis), characterised by severe nausea and vomiting in early pregnancy, has an unknown aetiology. The aim of the present study was to investigate food and nutrient intake before pregnancy and the risk of developing hyperemesis in women participating in the Norwegian Mother and Child Cohort Study. From 1999 to 2002, a total of 7710 pregnant women answered a FFQ about their diet during the 12 months before becoming pregnant and a questionnaire about illnesses during pregnancy, including hyperemesis. Only women who were hospitalised for hyperemesis were included as cases. Nutrient intakes during the year before pregnancy did not differ between the ninety-nine women who developed hyperemesis and the 7611 who did not. However, the intake of seafood, allium vegetables and water was significantly lower among women who developed hyperemesis than among women in the non-hyperemesis group. Relative risks of hyperemesis were approximated as OR, and confounder control was performed with multiple logistic regression. Women in the upper tertile of seafood consumption had a lower risk of developing hyperemesis than those in the lower tertile (OR 0·56, 95 % CI 0·32, 0·98), and women in the second tertile of water intake had a lower risk of developing hyperemesis than those in the first tertile (OR 0·43, 95 % CI 0·25, 0·73). The findings suggest that a moderate intake of water and adherence to a healthy diet that includes vegetables and fish are associated with a lower risk of developing hyperemesis.     

Elective pregnancy termination in a large cohort of women with hyperemesis gravidarum

Background

This study was conducted to describe characteristics of women who terminated their pregnancies secondary to hyperemesis gravidarum (HG).

Study Design

Data were obtained from a survey provided on an HG Web site from 2003 to 2005.

Results

Of 808 women who completed the survey, 123 (15.2%) had at least one termination due to HG, and 49 (6.1%) had multiple terminations. Prominent reasons given for the terminations were inability to care for the family and self (66.7%), fear that they or their baby could die (51.2%), or that the baby would be abnormal (22.0%). These same women were three times as likely to state that their health care providers were uncaring or did not understand how sick they were [64/123 (52.0%) vs. 168/685 (24.5%), odds ratio 3.34 (95% CI 2.21-5.05), p<.001].

Conclusion

These data suggest that the physical and psychological burden of HG has been underestimated, and that further education within the medical community may be warranted.     

肠内营养在胃瘫治疗中的作用

目的：探讨肠内营养支持在治疗胃大部切除术后胃瘫病人的效果。方法：通过肠内营养输注系统,输入肠内营养制剂,观察临床表现,并监测营养支持前后血糖、肝功能、血清电解质、血气分析及其他营养指标的变化。结果：所有病人均经保守治疗治愈,残胃功能恢复较快。在治疗过程中血糖,肝肾功能,电解质,血气分析均处于正常范围。体重、血红蛋白,血清总蛋白、白蛋白及氮平衡在营养支持后均有明显提高。结论：肠内营养支持能促进残胃功     

Experience of 6 years with home enteral nutrition in an area of Spain

OBJECTIVE: The wide spread use of long-term enteral nutrition and the substantive costs dictate a need to study outcome, clinical and epidemiological characteristics of these patients. The aim of our study was to analyze incidence and characteristics of a cohort of patients on HEN during 6 years, after our previous pilot study of 3 years. DESIGN: Prospective observational study. SETTING: Tertiary care. SUBJECTS: Between January 1999 and December 2004, all adult patients living in Valladolid West area who were discharged from the hospital on HEN were prospectively studied and followed up. INTERVENTIONS: Information for each patient was prospectively recorded by the dietitian of the team, and include age, sex, body mass index, tricipital skinfold, midarm circumference, underlying disease, exitus, dates of initiation and discontinuation of HEN, nutrient formula, mode of administration and complications of HEN. During HEN, physicians supervised the home patients and the patients themselves or their close relative, were asked to contact our nutrition team if any problem occurred. Finally the yearly incidence of HEN was calculated each year on the basis of the estimated population in our area of recruitment, assuming almost all HEN patients were reported. RESULTS: In our previous study, incidence of HEN in 1999 was patients 15 per 100,000 inhabitants, 21.3 in 2000 and decreased to 9.52 in 2001. In the new 3 years, the incidence remained in the mean levels of 1999 and 2000, the data were 17.1 per 100,000 inhabitants 26.5 in 2003 and 25.6 in 2004. The mean age of all patients was 56.4+/-17 years. The distribution of patients by diseases was; (43.8%) had a head and neck cancer, (26.8%) had human immunodeficiency virus infection, (9.6%) had a neurological disorders affecting swallowing (cerebrovacular accident and/or dementia), (4.7%) had diseases in digestive tract (fistulae, pancreatic disease, inflammatory bowel disease), (2.5%) had tumors in different locations with anorexia, (5%) had head trauma, and (7.6%) had one of several miscellaneous diseases inducing dysphagia or anorexia. HEN was administered via oral in 258 patients (70.6%) (group I), via a NGT in 95 patients (26.1%), a PEG in 9 patients (2.5%), and a jejunostomy in 3 patients (0.8%) (group II=107 patients). During the course of HEN, 12 patients had diarrhea (3.3%) and 8 (2.2%) constipation, and 4 vomiting (1.1%) that did not require cessation of HEN. No lung aspiration was detected. Hypernatremia (sodium >145 meq/l) appeared only in six cases (1.64%) and 12 cases of hyperglycaemia (3.28%). Ten patients (2.8%) reported a least one problem with the tube. The mean duration of HEN was 148.2+/-104 days. After the follow-up, 19 of the 365 patients (5.2%) had died, 346 (94.8%) were alive. In multivariant analysis, an independent factor associated with death was age (hazard ratio: 1.22; 95% CI: 1.06-1.39), adjusted by sex, route and diagnosis. CONCLUSIONS: HEN has a high incidence in our area and it is a valid and safe technique for nutrition support.     

Women's experiences with a pregnancy complication: causal explanations of hyperemesis gravidarum

There is a multiplicity of proposed causes, yet a scarcity of research regarding the pregnancy complication, hyperemesis gravidarum (HG), severe nausea and vomiting. This is not unlike other female medical conditions that have been underinvestigated, and perhaps as a result, erroneous assumptions about them persist. This is a report of qualitative findings from a larger study that investigated, in part, illness perspectives of 96 women with HG. Results reveal women view HG as biologically determined and that it has substantial impact on their daily functioning. The study challenges commonly held notions that HG is a psychosomatic disorder.     

Transient hyperthyroidism of hyperemesis gravidarum: a sheep in wolf's clothing

BACKGROUND: Transient hyperthyroidism of hyperemesis gravidarum (THHG) is a self-limiting hyperthyroidism occurring in the context of hyperemesis gravidarum. METHODS: A literature search of MEDLINE was undertaken, and a case report of a woman with THHG in pregnancy is described. RESULTS AND CONCLUSIONS: Because thyroid function tests cannot distinguish Graves disease from THHG, the diagnosis of THHG rests largely on the concurrent development of hyperemesis and hyperthyroidism and the absence of signs and symptoms of hyperthyroidism before and during pregnancy. THHG might be responsible for 40% to 70% of thyroid function abnormalities in pregnancy. Both the thyroid function abnormalities and hyperemesis are related to elevated levels of human chorionic gonadotropin. THHG resolves by 18 weeks of pregnancy without sequelae. No treatment is required. Diagnosis of THHG by the primary care provider can prevent unnecessary treatment or referral for specialty care.     

肠内营养在心力衰竭合并低钠血症病人治疗中的作用

目的:探讨肠内营养支持在心力衰竭合并低钠血症病人治疗中的作用.方法:将40例心力衰竭合并低钠血症的病人随机分为治疗组和对照组,每组各20例.对照组进行抗心力衰竭常规治疗并补钠;治疗组在常规抗心力衰竭治疗并补钠的同时,通过经肠营养途径进行营养支持,比较两组病人血钠值升至正常所需时间.结果:治疗组血钠升至正常所需时间为(5.30±1.82) d,对照组为(8.85±2.44) d,两组有显著性差异(P＜0.01).结论:肠内营养支持显著缩短了临床纠正心力衰竭合并低钠血症的时间.