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

Page: https://stenobird.com/podcast/dr-chapa-s-obgyn-clinical-pearls-334380/hg-ivfs-dextrose-ketones-lancet-2026
Text version: https://stenobird.com/podcast/dr-chapa-s-obgyn-clinical-pearls-334380/hg-ivfs-dextrose-ketones-lancet-2026.md
Podcast: [Dr. Chapa’s OBGYN Clinical Pearls](https://stenobird.com/podcast/dr-chapa-s-obgyn-clinical-pearls-334380)
Published: 2026-05-01T11:00:00+00:00
Episode link: https://podcasters.spotify.com/pod/show/dr-hector-chapa/episodes/HG-IVFs--Dextrose---Ketones--Lancet--2026-e3ifjv4
Audio file: https://traffic.megaphone.fm/APO8201179995.mp3
Processing state: processed
JSON: https://stenobird.com/v1/public/podcasts/dr-chapa-s-obgyn-clinical-pearls-334380/episodes/hg-ivfs-dextrose-ketones-lancet-2026
Duration seconds: 1567

## Resource

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that IV dextrose is necessary to clear ketones in hyperemesis gravidarum originated from a logical, and now known to be outdated, extrapolation of basic starvation ketosis physiology and the treatment paradigm for diabetic ketoacidosis (DKA).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 Not only is this outdated, but it is also physiologically incorrect.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. 2025;185(1):38-51. 4. ACOG Clinical Epert Series: Inpatient Management of Hyperemesis Gravidarium. Obstet Gynecol; 2024

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