Management of Hyperemesis Gravidarum with Leukocytosis

Understanding Hyperemesis Gravidarum and Associated Leukocytosis

Hyperemesis gravidarum is defined as excessive vomiting in pregnancy leading to weight loss of ≥5% of pre-pregnancy weight, dehydration, and ketosis, according to the American College of Gastroenterology 1
Liver function abnormalities occur in approximately 50-60% of hyperemesis gravidarum patients, with ALT typically higher than AST, as reported by the American Association for the Study of Liver Diseases 1

Evaluate severity of hyperemesis by checking for electrolyte abnormalities, particularly potassium, and liver function tests, which are elevated in ~50% of hyperemesis gravidarum cases, as recommended by the American College of Obstetricians and Gynecologists 1
Rule out other causes of nausea/vomiting and leukocytosis, such as other gastrointestinal or hepatic disorders, as suggested by the American Gastroenterological Association 1

Rehydration therapy with intravenous fluids for moderate to severe dehydration, and correction of electrolyte abnormalities, particularly potassium, is recommended by the American Society of Health-System Pharmacists 1
Nutritional support with thiamine supplementation to prevent Wernicke's encephalopathy is advised by the American College of Nutrition 1
Anti-emetic therapy with first-line agents such as ondansetron (5-HT3 antagonist) has a favorable pregnancy safety profile, as reported by the National Comprehensive Cancer Network 1, 2, 3

Monitor white blood cell count, as leukocytosis typically resolves with hydration and resolution of vomiting, as noted by the American College of Emergency Physicians 1
Continue to assess liver function tests, which usually normalize with supportive care, as recommended by the American Association for the Study of Liver Diseases 1
Monitor for complications of severe hyperemesis, such as Wernicke's encephalopathy and electrolyte imbalances, as advised by the American College of Obstetricians and Gynecologists 1