Superior Efficacy of 5% Dextrose-Saline versus Saline Alone in Rehydration for Hyperemesis Gravidarum: A Randomized Controlled Trial

Background: Hyperemesis gravidarum causes severe dehydration and ketoacidosis. Standard rehydration with 0.9% saline may not correct metabolic imbalances efficiently. Objective: This study aimed to compare the efficacy of 5% dextrose–0.9% saline versus 0.9% saline alone for rehydration in hyperemesis gravidarum. Patients and methods: This randomized controlled trial was conducted at Ain Shams University Maternity Hospital from October 2015 to October 2016. Eighty-eight pregnant women under 16 weeks of gestation with hyperemesis and ketonuria were randomized to receive either three litres of 5% dextrose–0.9% saline (n=44) or 0.9% saline (n=44) intravenously over 24 hours, following initial resuscitation. Primary outcomes were resolution of ketonuria and reduction in nausea scores at 24 hours. Secondary outcomes included electrolyte changes and hospital stay. Results: The dextrose-saline group demonstrated significantly higher rates of ketonuria resolution (86.4% vs. 63.6%, p=0.041) and greater reduction in median nausea scores at 24 hours (2 vs. 3, p<0.0001). Biochemically, the intervention group showed significantly better improvement in potassium (3.92 vs. 3.86 mmol/L, p=0.003) and a highly significant reduction in urea levels (15.86 vs. 18.14 mmol/L, p < 0.0001). The Number needed to treat for ketonuria resolution was 5. The difference in hospital stay was not statistically significant (28.91 vs. 30.11 hours, p=0.194). Conclusion: The addition of 5% dextrose to saline solution significantly improves clinical and metabolic recovery in hyperemesis gravidarum, leading to faster resolution of ketosis and nausea compared to saline alone.