Capillary ketones in hyperemesis gravidarum
Research type
Research Study
Full title
Is there a role for capillary ketones in the management of patients with hyperemesis gravidarum presenting to the Emergency Department (ED)?
IRAS ID
145510
Contact name
SHWETA GIDWANI
Contact email
Sponsor organisation
Chelsea and Westminster Hospital NHS Foundation Trust
Research summary
Nausea and vomiting in early pregnancy affects between 50-90% of pregnant women and thus it is a very common reason for these patients to attend the Emergency Department. Hypermesis gravidarum is a severe form of this ’morning sickness’, experience by less than 1% of pregnant women. It can cause dehydration and starvation and the production of compounds called ketones that can be found in the blood and urine. There is no standard definition of hyperemesis gravidarum but measurement of these ketones, along with clinical assessment, forms the basis of making this diagnosis and determining the need for intravenous rehydration, with or without anti-sickness medications.
Patients are routinely tested for the severity of nausea and vomiting in pregnancy by checking ketone levels in the urine at presentation, and later, reduction of these ketone levels is a marker for improvement following treatment. There are two ways to measure ketones - in the urine and in the blood. Currently urine ketone tests are the standard test but they may not reflect the actual ’real-time’ status of the patient as there is a time lag to clearing ketones from the urine.
There is now a body of evidence to support the use of blood ketone measurements over urinary levels in the management of diabetic ketoacidosis. Blood ketone levels fall quicker than urinary levels in response to treatment in diabetes and thus are felt to be a better marker of response to treatment. It is likely that this is also the case in patients with hyperemesis gravidarum but this has not previously been looked at in published studies. We hope that our study, in the future, may allow us to manage patients with hyperemesis gravidarum more effectively enabling earlier discharge from the Emergency Department with resultant cost savings and increased patient satisfaction.
REC name
North of Scotland Research Ethics Committee 1
REC reference
14/NS/0073
Date of REC Opinion
1 May 2014
REC opinion
Further Information Favourable Opinion