Last reviewed: 24 Apr 2022
Last updated: 12 Feb 2020
Summary
Definition
History and exam
Key diagnostic factors
- first trimester of pregnancy
- weight loss of >5%
More key diagnostic factors
Other diagnostic factors
- absence of thyroid enlargement/nodules
- absence of central nervous system (CNS) signs
- dry mucous membranes
- postural dizziness
- tachycardia
- hypotension
- ketotic breath
Other diagnostic factors
Risk factors
- family history of hyperemesis gravidarum
- previous history of NVP
- multiple gestation or increased placental mass
- gestational trophoblastic disease
- other causes of increased placental mass
- female fetus
- history of motion sickness
- history of migraine headache
More risk factors
Diagnostic investigations
1st investigations to order
- complete blood count
- basic metabolic panel
- serum liver function tests
- serum BUN and creatinine
- serum thyroid-stimulating hormone (TSH) and free thyroxine (T4)
- urinalysis
- urine or serum ketones
- fetal ultrasound with nuchal translucency
- serum analytes
- Helicobacter pylori breath test
More 1st investigations to order
Investigations to consider
- urine culture
- serum amylase and lipase
- abdominal ultrasound
- renal ultrasound
- cranial CT or MRI
More investigations to consider
Treatment algorithm
ACUTE
without volume depletion
without volume depletion but failed conservative management
with volume depletion
Contributors
Authors
Jeffrey D. Quinlan, MD
Associate Professor
Family Medicine
Uniformed Services University of Health Sciences
Bethesda
MD
Disclosures
JDQ declares that he has no competing interests.
Peer reviewers
Sarah Jorgensen, DO
Faculty Physician
Family Medicine Residency
Naval Hospital Jacksonville
FL
Disclosures
SJ declares that she has no competing interests.
Yosra Tahir Jarjees, MD
Assistant Professor
Head of Department of Obstetrics and Gynecology
Mosul College of Medicine
Mosul
Iraq
Disclosures
YTJ declares that he has no competing interests.
D. Ashley Hill, MD
Associate Director
Department of Obstetrics and Gynecology
Florida Hospital
Orlando
FL
Disclosures
DAH declares that he has no competing interests.
Differentials
- Viral gastroenteritis
- Food poisoning
- Cholecystitis
More DifferentialsGuidelines
- Nausea and vomiting of pregnancy
- The management of nausea and vomiting of pregnancy and hyperemesis gravidarum
More GuidelinesPatient leaflets
Morning sickness
Morning sickness: questions to ask your doctor
More Patient leafletsLog in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer