Laboratory Tests

• Dehydration, electrolyte imbalances, and acid-base disturbances may be evident in complex and prolonged nausea and vomiting.

• Dehydration is suggested by elevated blood urea nitrogen (BUN) and serum creatinine (SCr) concentrations, especially with a BUN to SCr ratio of 20:1 or greater (using traditional units of measurement).

• Calculated fractional excretion of sodium (FeNa) less than 1% in patients with compromised baseline renal function and less than 0.2% in patients with normal baseline renal function indicates dehydration and reduced renal perfusion.

• Low serum chloride and elevated serum bicarbonate levels indicate metabolic alkal-osis.

• Arterial blood gases with a normal or elevated pH indicates metabolic alkalosis that may or may not be compensated.

• Hypokalemia may occur from Gl potassium losses and intracellular potassium shifts to compensate for alkalosis.

Acupressure and acupuncture have been investigated based on the theory that certain points on the body control specific bodily functions.16 The P6 (Neiguan) point on the inside of the wrist has been used historically by acupuncturists to treat nausea and vomiting. While this approach seems safe and cost effective, efficacy data in the treatment of NVP are conflicting. The majority of studies showed a benefit to this

12 18

approach, but the studies had methodological flaws. ' P6 acupressure and elec-troacupoint stimulation have also been investigated as preventative tools for PONV and motion sickness.19-21

Hypnosis maybe effective for severe NVP. Psychotherapy is another noninvasive treatment approach that is safe during pregnancy or in situations in which adverse treatment effects and drug interactions are a concern. One small study suggested that patients with hyperemesis gravidarum may benefit from the combination of psychotherapy and antiemetics.

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