Hyperemesis Gravidarum with Metabolic Disturbance: Management When Second-Line Antihistamine Therapy Has Failed
This protocol applies to patients with hyperemesis gravidarum with metabolic disturbance who have not achieved adequate control after second-line pharmacotherapy. When antihistamine treatment fails to produce sufficient improvement, a further escalation step is required.
Previous Treatment — Failure Condition
Second-line pharmacotherapy with a sedating antihistamine (Promethazine) did not achieve the required reduction in the severity and frequency of nausea and vomiting. This unmet goal is the indication for the current protocol.
Clinical Goal
Reduction in the severity and frequency of nausea and vomiting.
Treatment Approach
Following failure of second-line antihistamine therapy, a third-line pharmacotherapy approach using a distinct class of antiemetic agents is indicated. The complete options, selection criteria, and clinical parameters are detailed in the full protocol.