Nausea and vomiting is common during early pregnancy ("morning sickness") but is usually mild. Rarely a woman may experience severe, persistent nausea and vomiting sufficient to cause significant metabolic derangements requiring hospitalization.


Features of hyperemesis gravidarum:

(1) severe and persistent nausea and vomiting

(2) weight loss (greater than 5% of prepregnancy weight)

(3) moderate to severe dehydration

(4) electrolyte and acid base disturbances (hypochloremia, hyponatremia, metabolic acidosis)

(5) ketonuria


Differential diagnosis:

(1) normal levels of emesis

(2) bowel obstruction

(3) acute viral infections with gastrointestinal manifestations

(4) diabetic ketoacidosis

(5) urinary tract infection



(1) malnutrition

(2) vitamin deficiencies, especially thiamine

(3) refeeding syndrome during nutritional repletion


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