Hyperemesis gravidarum with metabolic disturbance involves severe, sustained nausea and vomiting in pregnancy. When pharmacotherapy progresses through multiple lines without achieving adequate control, a structured next-step protocol is indicated.
Previous Treatment — Insufficient Response
Third-line pharmacotherapy — Metoclopramide or Prochlorperazine — did not adequately reduce the severity and frequency of nausea and vomiting. This protocol represents the appropriate next step after that failure.
Next Step — Fourth-Line Pharmacotherapy
A fourth-line antiemetic agent is specified for cases where prior antiemetics have been ineffective or poorly tolerated. When reflux is concurrently present, the protocol incorporates targeted reflux management, as addressing reflux can further improve nausea and vomiting. The complete regimen and administration details are available in the full protocol.
Clinical Goal
Reduction in the severity and frequency of nausea and vomiting