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Lack of efficacy: case report A 28-year-old woman exhibited lack of efficacy on ondansetron, prednisolone and metoclopramide during treatment for hyperemesis gravidarum in pregnancy. The woman was admitted with severe nausea and vomiting. She experienced untolerated frequent abdominal cramps. Following investigation, a diagnosis of oesophageal perforation was made, she was treated accordingly. It was reported that, she had started experiencing nausea and vomiting in the second week of pregnancy, and diagnosis of hyperemesis gravidarum was made in the sixth week of pregnancy. Subsequently, she started receiving treatment with ondansetron 8 mg/day, prednisolone 8 mg/day and metoclopramide 10 mg/day [routes not stated] for over 1 month; however, no relief was observed in the symptoms of hyperemesis gravidarum (lack of efficacy). By the eighth week of pregnancy, she experienced weight loss and had ketonuria. Later, based on further examinations, the woman started receiving oral mirtazapine 15mg. She tolerated the food and beverages for the first time within two hours after receiving the mirtazapine. After one week, nausea and vomiting significantly decreased. Her treatment mirtazapine was continued for 60 days. Following discontinuation of mirtazapine treatment, the nausea level was tolerable. At 38 weeks of gestation a vaginal delivery was performed and normal neonate was delivered. At follow-up after delivery, she had no issues. Kul AT, et al. Rapid efficacy of mirtazapine in the treatment of hyperemesis gravidarum with esophagus perforation and ketonuria in a normoglycemic patient: A case report. 803515470 Dusunen Adam 33: 206-209, No. 2, 2020. Available from: URL: http://doi.org/10.14744/DAJPNS.2020.00080

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Reactions 21 Nov 2020 No. 1831