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HELP needed -- hypermesis gravidarum

hypermesis gravidarum

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#1 tolerant

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Posted 08 April 2016 - 04:25 PM


I have a sister-in-law is greatly suffering from the above condition -- basically a severe and constant condition of morning sickness.

She is on medication, but I hope that maybe someone out there knows of treatment outside of those prescribed by doctors.

Secondly, she would be greatly relieved if a nurse could come to her house and put her on a drip -- a service available in the US, but not here in Australia as we're always several years behind at least.

We have someone who is trained in blood collection and therefore can administer the needle into the vein. We can purchase a standard 1000 ml saline drip bag. I will look where to obtain the other necessary parts, but I'm looking for advice on what these other parts are, how to put it all together, what are the safety precautions, what should the drip rate be and how it is set, how much hydration she needs, what other nutrients she needs (she practically doesn't eat, doesn't drink enough, and vomits at least several times a day), and how these nutrients are added to the saline.

Maybe someone with experience of self-administration of supplements via IV can help?

Edited by tolerant, 08 April 2016 - 04:29 PM.

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#2 Dorian Grey

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Posted 08 April 2016 - 04:40 PM

Don't know if you can get PPC (polyenylphosphatidylcholine) down under, but it is supposed to be safe and effective for HG.

 

http://www.phoschol....Prescribing.pdf

 

"Gestosis A total of 684 patients in 13 studies received as adjuvant treatment 250-1000 mg of PPC intravenously and/or 1.8 g PPC orally per day. In these patients suffering from early or late gestosis, the subjective symptoms, such as hyperemesis gravidarum, clearly improved or disappeared. This positive effect was also seen with respect to accompanying disturbances, such as lipid peroxidation, renal disorders, pathological liver function and hyperlipidemia."

 

PPC is found in a supplement called "Essentiale Forte" in many areas outside the US.

 

Don't know if simple Lecithin or increased egg (yolk) consumption might also help if you can't get PPC (PPC is a component of Lecithin & eggs are the best natural source), but it may be worth a try.  The lecithin is in the yolks, so this is all you need.  Minimal cooking (soft scrambled, over easy, sunny side up or soft boiled) will provide the maximum effect.  

 

Dipping some toast into the runny yolk of a sunny side egg might be the most palatable way to eat this.  

 

I would also try discontinuing supplemental iron in prenatal vitamins.  Iron is notorious for wrecking the gut and is only necessary when and if hemoglobin/hematocrit becomes low.  Most prenatal vitamins contain way too much iron and this causes more harm than good in many pregnant women.  


Edited by synesthesia, 08 April 2016 - 05:29 PM.


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#3 tolerant

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Posted 10 April 2016 - 05:09 AM

Don't know if you can get PPC (polyenylphosphatidylcholine) down under, but it is supposed to be safe and effective for HG.

 

http://www.phoschol....Prescribing.pdf

 

"Gestosis A total of 684 patients in 13 studies received as adjuvant treatment 250-1000 mg of PPC intravenously and/or 1.8 g PPC orally per day. In these patients suffering from early or late gestosis, the subjective symptoms, such as hyperemesis gravidarum, clearly improved or disappeared. This positive effect was also seen with respect to accompanying disturbances, such as lipid peroxidation, renal disorders, pathological liver function and hyperlipidemia."

 

I would also try discontinuing supplemental iron in prenatal vitamins.  Iron is notorious for wrecking the gut and is only necessary when and if hemoglobin/hematocrit becomes low.  Most prenatal vitamins contain way too much iron and this causes more harm than good in many pregnant women.  

 

Thank you for your suggestions. The PPC is a nice find, although I am unable to find the study referred to or anything similar on PubMed. So at this stage it looks just like marketing material.

 

With respect to iron, do you think a few days without supplementation would be enough to know whether the person is better off without it?



#4 Dorian Grey

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Posted 10 April 2016 - 04:39 PM

Studies of supplements on pregnant humans are difficult to do.  Apparently, a fellow (Mücke, H.G.) did manage to do one and wrote a paper: The treatment of vomiting in pregnancy with Essentiale

Der Landarzl 39 (1963) 34-35

 

Apparently, high estrogen levels that occur during pregnancy can cause cholestasis (thick/muddy bile), which can contribute to the nausea/emesis of pregnancy. Lecithin thins bile, helping it to flow freely again and ameliorating the problem.  

 

Her doc might not approve of supplemental Lecithin, but shouldn't have a problem with eating eggs.  

 

Prenatal vitamins typically are simple/basic multivitamins with additional folic acid and a ton of iron.  As long as she's not anemic, I can't see how switching to an iron free multi for a week or two might be unwise to see if this might help.  If you research pregnancy forums, you'll see supplemental iron causes a lot of problems and a lot of women stating they had to discontinue the iron due to nausea and vomiting they experienced from it.  I would hope her doc might be helpful with this regarding advice on an alternate supplement without iron for a trial period.  I'm sure this isn't the first patient he/she might have encountered who had major issues with high-iron prenatals.  



#5 tolerant

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Posted 19 April 2016 - 03:47 AM

Thank you synesthesia,

 

My sister-in-law is now taking lecithin and apparently improving very slowly since she started taking it (of course could be coincidence of placebo). I was trying to find out how much PPC there is in lecithin but couldn't it anywhere on the Internet. Maybe there's no one single correct answer.

 

Thank you again,

 

tolerant



#6 Kinesis

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Posted 19 April 2016 - 04:37 AM

Glad to hear your sister-in-law is improving. I don't have exact data either, but there should be plenty polyenylphosphatidylcholine in good quality lecithin. Phosphatidylcholine by definition has two fatty acid moieties in it, and most of the fatty acids in soy and sunflower (from which most commercial lecithin is made) are polyenyl, that is polyunsaturated. Polyenyl is just a fancy way of saying there are multiple double (unsaturated) bonds,

#7 Dorian Grey

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Posted 19 April 2016 - 03:59 PM

I remember reading about the ratios of the various components of lecithin and PPC content, but can't find this now.  As I recall, the PPC content of simple lecithin was quite low.  PPC is highly refined.  

 

"Essentiale Forte" is a pharmaceutical grade PPC supplement made by sanofi aventis that is generally available world wide.  Perhaps you might seek this out and see if it is available in Australia.  As always, best to ask her doc about taking this first. 

 

Glad you're getting some results from the Lecithin, and hope she continues to improve.  

 

What did the doc say about the iron?  Has she tried going off this briefly to see if this might help?  


Edited by synesthesia, 19 April 2016 - 04:09 PM.


#8 tolerant

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Posted 20 April 2016 - 02:26 AM

I remember reading about the ratios of the various components of lecithin and PPC content, but can't find this now.  As I recall, the PPC content of simple lecithin was quite low.  PPC is highly refined.  

 

"Essentiale Forte" is a pharmaceutical grade PPC supplement made by sanofi aventis that is generally available world wide.  Perhaps you might seek this out and see if it is available in Australia.  As always, best to ask her doc about taking this first. 

 

Glad you're getting some results from the Lecithin, and hope she continues to improve.  

 

What did the doc say about the iron?  Has she tried going off this briefly to see if this might help?  

 

Yes, I'm aware of Essentiale Forte, and also ProSchol, which supply pure PPC. We don't have either in Australia, but could always buy from Amazon or something. With regards to the iron, she knows it makes her condition worse, so she just takes some from time to time because she was low in iron at some stage.



#9 Dorian Grey

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Posted 20 April 2016 - 03:11 AM

Iron deficiency doesn't usually become problematic until the third trimester when the baby is getting large and growing fast.  Hyperemesis is typically most problematic in the first & second trimester, so forcing sick women to mega-dose iron early in pregnancy may not be wise if they are not clinically anemic.  

 

Ferritin is a dirt cheap iron lab (blood test) that will reliably indicate how badly she needs supplemental iron.  Anything much under 25 would indicate a need for supplementation, but if ferritin is up around 30-40 supplementation may not be imperative at this time.  

 

Edited by synesthesia, 20 April 2016 - 03:24 AM.


#10 tolerant

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Posted 20 April 2016 - 03:16 AM

Glad to hear your sister-in-law is improving. I don't have exact data either, but there should be plenty polyenylphosphatidylcholine in good quality lecithin. Phosphatidylcholine by definition has two fatty acid moieties in it, and most of the fatty acids in soy and sunflower (from which most commercial lecithin is made) are polyenyl, that is polyunsaturated. Polyenyl is just a fancy way of saying there are multiple double (unsaturated) bonds,

 

Thanks for that. So if I understand correctly, if I order something like this, which is Phosphatidyl Choline and not Polyenyl Phospatidyl Choline (PPC), I can rest assured that I am still getting PPC, which was referred to in study on pregnancy, by default?


Edited by tolerant, 20 April 2016 - 03:17 AM.


#11 Kinesis

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Posted 20 April 2016 - 06:29 PM

Well tolerant, according to the label this product has 420 mg phospatidylcholine per softgel.  It doesn't list the fatty acid breakdown, but according to http://nutritiondata...-and-oils/592/2 a one cup sample of soy lecithin has 32.7 g saturated fat, 23.9g monounsaturated fat, and 98.8g polyunsaturated fat.  Then the latter fatty acid content is 98.8/(32.7+23.9+98.8)=0.636 of total ... or 63.6% polyunsaturated (polyenyl).  So of the 420 mg of phospatidylcholine, we can estimate that about 0.636*420 = 267 mg is polyunsaturated (polyenyl).

 

The bottom line, of course, is whether your sister-in-law is getting better.  Often such conditions will resolve on their own, so it's hard to say just based on that whether the supplement is helping, but we can be pretty sure the risk is low.  Lecithin is common in foods both natural and processed and is even found in infant formula and baby food, so the downside of taking it in recommended amounts is virtually nil.  Like almost all supplements, the label advises that in the case of pregnancy to consult a doctor before taking, so there's your official advice.  But I think we can safely say that this product has a significant amount of polyenylphospatidylcholine, probably around 267 mg.  In general, unless stated otherwise, you can estimate that 0.636 (63.6%) of phosphatidylcholine from soy lecithin is polyenyl.

 

 


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#12 tolerant

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Posted 19 May 2016 - 05:26 AM

Thank you synesthesia and Kinesis for your help. You're both very knowledgeable in your respective fields! My sister-in-law is now improving at a rate of knots. The condition is resolving on its own, as it always does (this is her fourth time dealing with it). She ended up taking very little lecithin. Initially she took only once 1200 mg capsule per day. The bottle didn't specify how much phosphatidylcholine is in it, but a quick look at other brands of lecithin reveals that one 1200 mg capsule can contain from 26 mg to 210 mg of phosphatidylcholine. Considering only a fraction of that amount will be PPC as Kinesis said, the amounts are lower still, which is well short of the 1800 mg used in the unreferenced study. I toyed with the idea of getting her pure PPC, but considering she was improving and for reasons outlined in this article, I decided against it. There are simply no teratogenicity (the property or capability of producing congenital malformations) studies on this. At least with anti-emetic drugs there are studies and you know where you stand. I'm guessing 1.8 g of PPC would probably be in excess, perhaps far in excess, of 10 times the natural intake of the stuff. Yes, it's natural, but you wouldn't recommend a pregnant woman take 10 times the RDI of, say, zinc or iron, would you? When we asked the obstetrician about lecithin, he said consult your pharmacist, and the pharmacist in turn said that the stuff is benign. It may very well be so, but that's slack advice on their part.  



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#13 Dorian Grey

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Posted 21 May 2016 - 01:00 AM

This paper: http://phoschol.com/...annComplete.pdf

 

has a few animal studies on teratogenicity, but yes, always a risky business when dealing with supplements during pregnancy.  I know they are now saying too much folic acid is being associated with autism, and prenatals typically contain a double dose of FA @ 800mcg.  Take more than one a day and you're really mega-dosing the FA.  

 

2.5.3 Teratogenicity and Embryotoxicity of EPL No toxic effects of EPL on pregnant rats or fetuses were observed either when doses of up to 1,000 mg/kg b.w. were administered to rats or up to 500 mg/kg b.w. to rabbits. <%Tab. 9:%> Similar results were found when using Essentiale or Lipostabil ampoules in doses of up to 1.2 ml/kg b.w. in rats or rabbits (411, 435, 671, 673). 2.5.4 Perinatal and Postnatal Toxicity, Fertility and Reproductive Performance Perinatal and postnatal development of rats is not influenced by oral EPL doses of up to 3,750 mg/kg b.w./day. When the substance was applied until the end of the third lactation week all parameters were found to be within the normal histological range (210). Male rats received EPL 10 weeks and female animals 2 weeks before the beginning of the test. Oral doses of 150, 750 and 3,750 mg/kg b.w. were applied a day (211). Even with the highest dose no effect of EPL on male and female fertility nor on the reproductive performance was observed. An increase in dominant lethals could not be found. The Essentiale and Lipostabil ampoules neither influenced the fertility nor the reproductive performance of the rats (413, 434).


Edited by synesthesia, 21 May 2016 - 01:03 AM.






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