Intravenous (IV, meaning directly into the vein) fluids are given to correct dehydration, and medication can be given through the IV port when oral medication is unable to be tolerated.
Although IV therapy is common and some doctors would prefer to repeatedly prescribe IV fluids rather than medication for pregnant women, they are not without risk. The main risk associated with IV therapy lies at the site of cannulation. Blood and fluids can leak in to surrounding tissues causing damage and pain. Repeated cannulations can lead to destruction of the vein by scar tissue making future cannulations impossible. Infection is a big risk, and in the days of antibiotic-resistant strains of bacteria such as MRSA, treating infection can be difficult.
However, IV fluid replacement does remain an effective treatment for dehydration, which actually can cause nausea and vomiting. Women often feel temporary but effective relief from a few bags of IV fluids.
Recently, in rural areas around the United Kingdom, there is an increasing service provision for IV fluids to be administered at home which is an exciting development for HG sufferers who can find the trip to and from hospital and the ward environment quite distressing and exacerbating of symptoms. In particular, a pioneering service led by community nurse Emma Moxham, near Bath in the south west of England, has been successfully providing IV at home for women with HG for about 3 years now and interest in the service is increasing in other areas too. Click here for more information.
In inner city areas there is an increasing move towards IV day clinics where hyperemesis patients can be rapidly rehydrated during the day and go home in the evening. For more information click here.
Dr Marjory Maclean, consultant obstetrician at Ayrshire Maternity Unit in Scotland, suggests a suitable regime for fluid replacement as follows:
If significant ketonuria, 1000 ml 0.9% sodium chloride intravenously over 2 to 4 hours. Hartmann’s can also be used.
Thereafter fluids should be reduced to 500 ml 4–6 hourly, the regime being guided by U&E results, which should be performed daily, particularly for monitoring potassium levels.
Avoid glucose initially as it contains insufficient sodium and especially as Wernicke’s encephalopathy may be precipitated unless thiamine is given first.