What should I do when I can't keep down food and fluids?

The short answer: seek timely help

If you are pregnant and cannot keep down any fluids or food, the answer is unequivocal: you must seek medical help that same day. This is especially critical if you are vomiting an essential medication prescribed by your doctor or have been unable to consume fluids for several hours.

Nausea in pregnancy is very common, but persistent vomiting is a different situation. Some sources recommend seeking medical attention if you cannot keep down fluids for 24 hours, but this is not a waiting period for those already experiencing symptoms of dehydration. If your condition worsens, you feel weak, or your urination has decreased, seek advice immediately. Remember, this is not your fault, and you are not expected to manage this situation alone. Seeking timely help is the safest step for both your health and your baby's.

Simple nausea vs. hyperemesis gravidarum: what's the difference?

Nausea and vomiting in pregnancy, commonly referred to as “morning sickness,” can occur at any time of day. This is a common condition in most pregnant women and usually subsides by 16-20 weeks. There is no evidence that mild to moderate pregnancy nausea has a harmful effect on the baby; however, severe and persistent vomiting should be evaluated separately.

However, in some cases, this condition progresses to a more severe form called Hyperemesis Gravidarum (HG). This is a serious medical condition that can be seen in approximately 3 out of 100 pregnant women. The main difference of HG is its severity:

• Simple nausea: Causes discomfort but usually allows you to continue your daily life and consume some food and fluids.
• Hyperemesis Gravidarum (HG): Is so severe that it can significantly restrict your daily activities, preventing you from eating and drinking normally. This can lead to dehydration and malnutrition.

Research shows that HG is a genetic predisposition linked to high levels of a hormone called GDF-15 secreted by the placenta. This is not a psychological problem or your fault, but a real physical condition.

How to recognize dehydration?

Dehydration occurs when your body does not receive enough fluids. This is a serious risk during severe vomiting. Pay attention to the following symptoms, as they indicate that your body urgently needs fluids:

• Urine color and quantity: Your urine being very dark yellow or brown. Not urinating for more than 8 hours is a serious signal.
• Dry mouth and skin: A strong feeling of thirst, with your mouth and lips feeling dry.
• General malaise: Feeling dizzy, weak, or fainting when standing up.
• Fatigue and drowsiness: Feeling excessively tired or sleepy.

If you experience any of these symptoms, you should seek medical help immediately. Untreated dehydration can be dangerous for both your health and your baby's.

When to see a doctor immediately: Don't wait!

Some symptoms require immediate medical attention. In the following cases, contact your doctor, midwife, or local emergency service without delay:

Call emergency services immediately in the following situations:

• Severe abdominal pain
• Vomiting blood
• Severe weakness, dizziness, or fainting when standing up
• Confusion or disorientation

In the following cases, contact a doctor or midwife urgently:

• If you cannot keep any fluids or food down (do not wait 24 hours in this situation).
• If you have not urinated for more than 8 hours or your urine is very dark.
• If you have a high temperature (fever).
• If you are rapidly losing weight.
• If nausea and vomiting started after the 16th week of pregnancy (this could be due to other causes).

Remember, only a healthcare professional can accurately assess your condition. Do not hesitate to seek advice if you have any doubts.

Small steps you can take while waiting for help

While arranging to see a doctor, you can try some methods to alleviate your condition slightly. Only try these if you can tolerate them. If you cannot keep down any fluids or your condition worsens, do not delay medical help to try these methods.

• Drink small amounts frequently: Instead of drinking large glasses of water, consume small sips of water or other fluids throughout the day.
• Prefer cold foods: The smell of hot food can increase your nausea. Cold or room-temperature foods may be easier to tolerate.
• Choose simple and light foods: Fat-free, carbohydrate-rich foods (dry toast, salty crackers, rice, pasta) may irritate your stomach less.
• Avoid trigger smells: Identify which foods or scents increase your nausea and avoid them.
• Ginger: Some studies suggest that ginger can reduce nausea. You can try ginger tea or foods, but consult a pharmacist before taking any ginger supplements during pregnancy.
• Oral Rehydration Salts (ORS): These special solutions sold in pharmacies can help restore lost fluids and electrolytes. Always follow the pharmacist's instructions before use.

What to expect during a doctor's examination?

When you visit a doctor or hospital, you will be asked a series of questions and undergo some examinations to accurately assess your condition. Being prepared for this can make you feel more comfortable.

Your doctor may ask:

• How long have your symptoms been ongoing?
• How much fluid and food can you keep down?
• Have you tried any medications?
• Have you rapidly lost weight?
• Do you have other symptoms like abdominal pain or pain when urinating?
• Have you experienced this condition in previous pregnancies?

Examinations that may be performed:

• Physical examination: Your temperature, pulse, respiratory rate, and blood pressure will be measured. Your weight will be checked, and signs of dehydration will be assessed.
• Urine analysis: For example, to check for signs of infection. A ketone result or a specific weight loss threshold is not required to receive help.
• Blood analysis: To check if your electrolytes, kidney, and liver functions are normal.
• Ultrasound scan (USS): If you have not yet had an USS, it may be offered to confirm your gestational age and check for conditions like twin pregnancy.

Treatment options: A personalized approach

Treatment for severe nausea and vomiting is planned individually for each woman. The primary goal is to alleviate dehydration and control symptoms.

Hospital treatment may include:

• Intravenous fluids (drip): If you cannot drink fluids, fluids will be administered through a vein in your arm to restore your body's water and electrolyte balance.
• Anti-nausea medications (antiemetics): Various medications are available to stop vomiting. If you cannot swallow pills, they can be given as injections or suppositories. The doctor will explain the benefits and risks, side effects, and administration route of the medication for you.
• Vitamins: Prolonged vomiting can lead to deficiencies in some vitamins, especially thiamine, which is vitamin B1. This vitamin can be administered intravenously.
• Prevention of blood clots: Prolonged immobility in the hospital and dehydration increase the risk of blood clots (thrombosis). To reduce this risk, special elastic stockings or heparin injections to thin the blood may be prescribed.

Untreated severe vomiting also poses risks; therefore, it is more beneficial to express your concerns about medications and discuss a personalized benefit-risk plan.

After returning home: Next steps

After being discharged from the hospital, it is important to continue treatment and prevent the recurrence of symptoms. Your doctor will likely prescribe anti-nausea pills for you to take at home.

• Take your medications regularly: Even if you feel better, continue taking the medications prescribed by your doctor. Contact your doctor for a new prescription before your medications run out.
• If symptoms recur: If vomiting intensifies again and you cannot keep down fluids or medication, contact the medical team for re-evaluation that same day. Do not increase the dose on your own and do not wait for the condition to worsen further before seeking help.
• Long-term monitoring: If severe nausea and vomiting continue after 20 weeks, your doctor may suggest additional ultrasound scans to monitor your baby's growth in later stages of pregnancy.

Although this can be a difficult period, know that in most cases, symptoms improve or disappear completely after your baby is born.

Support from loved ones and emotional well-being

Hyperemesis gravidarum is not only physically but also emotionally a very exhausting experience. This condition can negatively affect your mood, work, home life, and social relationships. It is normal to feel isolated or guilty, but you should not be alone with these feelings.

How can your loved ones help?

• Show understanding: It is important for them to understand that this condition is a real medical problem and that you are not “being fussy.”
• Practical help: Helping with household chores, meal preparation (especially odorless meals), or caring for other children can significantly reduce your burden.
• Avoid triggers: Small changes like not cooking strong-smelling foods at home or not using strong perfumes can make a big difference.

If you feel anxious, depressed, or excessively stressed, share this with your doctor or midwife. They can help you get the necessary emotional support. Remember, being compassionate with yourself during this period is very important.

You can use the Anacan Calendar to record all important appointments and dates related to your pregnancy.