This protocol applies when initial supportive care for hyperemesis gravidarum with metabolic disturbance has not achieved the required goals — specifically when dehydration and electrolyte abnormalities persist, ketonuria continues on daily testing, or the patient cannot tolerate oral fluids and diet.
Supportive management was the initial approach — comprising dietary and lifestyle modifications, IV fluid rehydration, correction of electrolyte abnormalities, and Thiamine supplementation. Escalation to the current protocol is indicated when that line fails to achieve: correction of dehydration and electrolyte abnormalities, absence of ketonuria on daily urine testing, and tolerance of oral fluid and diet.
When supportive measures have not achieved the required clinical goals, first-line oral pharmacotherapy is indicated — a scheduled combination approach aimed at reducing the severity and frequency of nausea and vomiting. The complete regimen, including agents, dosing, and dose-adjustment guidance, is available in the structured protocol.