HG: IVFs, Dextrose, & Ketones? (Lancet, 2026)

About this episode

This episode discusses outdated beliefs about IV dextrose in treating hyperemesis gravidarum and recent findings on fluid replacement and ketone monitoring.

The belief that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA). The original experiments that led to this conclusion go back to the 1960s (Foster data). Not only is this outdated, but it is also physiologically incorrect. We’ve learned a lot about IV fluid replacement about hyperemesis gravidarum in the last several years- in the last data review was in January 2026 in Lancet. Even the correction of hyponatremia has evolved. Should we be following urine ketones for patients being treated for HG? Is Dextrose needed? Listen in for details. 1. Nana M, Painter R, Williamson C et al. Hyperemesis gravidarum. The Lancet, Jan 2026; 407, 78-89 2. Clark SM, Zhang X, Goncharov DA. Inpatient Management of Hyperemesis Gravidarum. Obstet Gynecol. 2024 Jun 1;143(6):745-758. doi: 10.1097/AOG.0000000000005518. Epub 2024 Feb 1. PMID: 38301258. 3. Ayus JC, et al.Correction rates and clinical outcomes in hospitalized adults with severe hyponatremia: a systematic review and meta-analysis. JAMA Intern Med…

People in this episode

Host: Hector Chapa

Topics covered

• hyperemesis gravidarum
• IV dextrose
• ketones
• diabetic ketoacidosis
• fluid replacement
• hyponatremia
• urine ketones

Keywords

• hyperemesis gravidarum
• IV dextrose
• ketones
• diabetic ketoacidosis
• fluid replacement
• hyponatremia
• urine ketones
• Lancet
• Obstet Gynecol
• JAMA Intern Med

Mentioned in this episode

Organizations: Lancet, Obstet Gynecol, JAMA Intern Med, ACOG

Books & works: Hyperemesis gravidarum, Inpatient Management of Hyperemesis Gravidarum

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