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Randomized Controlled Trial
. 2013 Feb;121(2 Pt 1):291-298.
doi: 10.1097/AOG.0b013e31827c5e99.

Dextrose saline compared with normal saline rehydration of hyperemesis gravidarum: a randomized controlled trial

Peng Chiong Tan  1 , Mat Jin Norazilah, Siti Zawiah Omar
Affiliations
Randomized Controlled Trial

Dextrose saline compared with normal saline rehydration of hyperemesis gravidarum: a randomized controlled trial

Peng Chiong Tan et al. Obstet Gynecol. 2013 Feb.

Abstract

Objective: To compare 5% dextrose-0.9% saline against 0.9% saline solution in the intravenous rehydration of hyperemesis gravidarum.

Methods: Women at their first hospitalization for hyperemesis gravidarum were enrolled on admission to the ward and randomly assigned to receive either 5% dextrose-0.9% saline or 0.9% saline by intravenous infusion at a rate 125 mL/h over 24 hours in a double-blind trial. All participants also received thiamine and an antiemetic intravenously. Oral intake was allowed as tolerated. Primary outcomes were resolution of ketonuria and well-being (by 10-point visual numerical rating scale) at 24 hours. Nausea visual numerical rating scale scores were obtained every 8 hours for 24 hours.

Results: Persistent ketonuria rates after the 24-hour study period were 10 of 101 (9.9%) compared with 11 of 101 (10.9%) (P>.99; relative risk 0.9, 95% confidence interval 0.4-2.2) and median (interquartile range) well-being scores at 24 hours were 9 (8-10) compared with 9 (8-9.5) (P=.73) in the 5% dextrose-0.9% saline and 0.9% saline arms, respectively. Repeated measures analysis of variance of the nausea visual numerical rating scale score as assessed every 8 hours during the 24-hour study period showed a significant difference in favor of the 5% dextrose-0.9% saline arm (P=.046) with the superiority apparent at 8 and 16 hours, but the advantage had dissipated by 24 hours. Secondary outcomes of vomiting, resolution of hyponatremia, hypochloremia and hypokalemia, length of hospitalization, duration of intravenous antiemetic, and rehydration were not different.

Conclusions: Intravenous rehydration with 5% dextrose-0.9% saline or 0.9% saline solution in women hospitalized for hyperemesis gravidarum produced similar outcomes.

Clinical trial registration: ISRCTN Register, www.controlled-trials.com/isrctn, ISRCTN65014409.

Level of evidence: I.

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References

    1. Verberg MF, Gillott DJ, Al-Fardan N, Grudzinskas JG. Hyperemesis gravidarum, a literature review. Hum Reprod Update 2005;11:527–39.
    1. Tan PC, Jacob R, Quek KF, Omar SZ. The fetal sex ratio and metabolic, biochemical, haematological and clinical indicators of severity of hyperemesis gravidarum. BJOG 2006;113:733–7.
    1. Nausea and vomiting of pregnancy. ACOG Practice Bulletin No. 52. American College of Obstetrics and Gynecology. Obstet Gynecol 2004;103:803–16.
    1. Gazmararian JA, Petersen R, Jamieson DJ, Schild L, Adams MM, Deshpande AD, et al.. Hospitalizations during pregnancy among managed care enrollees. Obstet Gynecol 2002;100:94–100.
    1. Tan PC, Tan NC, Omar SZ. Effect of high levels of human chorionic gonadotropin and estradiol on the severity of hyperemesis gravidarum. Clin Chem Lab Med 2009;47:165–71.

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