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HELLP Syndrome, Emergency Medicine

Michael J. Bono Reviewed 06/2017
 


Basics

Description

  • HELLP syndrome: Hemolysis Elevated Liver enzymes, Low Platelets

  • Continuum with severe preeclampsia as most patients will be hypertensive

  • Liver involvement is hallmark:

    • Other organs may ...

Diagnosis

Signs and Symptoms

History

  • History and physical exam with attention to symptoms of abdominal pain, nausea, vomiting, and headache

  • Obstetric history:

    • Parity

    • Deliveries

    • History of hypertensive disor...

Treatment

Pre-Hospital

Cautions: 
  • Transport patient in left lateral decubitus position to prevent inferior vena cava syndrome

  • Venous access for anticipated seizure activity

  • Routine seizure management (pre...

Follow-Up

Disposition

Admission Criteria

  • Admit all patients to obstetric service for continuous monitoring of mother and fetus

  • ICU admission:

    • Pulmonary edema

    • Respiratory failure

    • Cerebral edema

    • GI bleeding wi...

Pearls and Pitfalls

  • Hypertensive pregnant women with abdominal pain, elevated LFTs, and decreased platelets need emergent treatment and OB consultation

  • Patients with HELLP syndrome may have a normal BP

  • ...

Additional Reading

  • Ciantar  E, Walker  JJ. Pre-eclampsia, severe pre-eclampsia and hemolysis, elevated liver enzymes and low platelets syndrome: What is new? Women's Health.  2011;7(5):555–569.

  • De...

Codes

ICD9

  • 642.50 Severe pre-eclampsia, unspecified as to episode of care

  • 642.51 Severe pre-eclampsia, delivered, with or without mention of antepartum condition

  • 642.52 Severe pre-eclampsia, delivered, w...

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