Last reviewed: 1 Nov 2024
Last updated: 17 Jan 2023
Summary
Definition
History and exam
Key diagnostic factors
- first trimester of pregnancy
- weight loss of >5%
Full details
Other diagnostic factors
- absence of thyroid enlargement/nodules
- dry mucous membranes
- postural dizziness
- tachycardia
- hypotension
- ketotic breath
Full details
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
Full details
Diagnostic tests
1st tests to order
- clinical diagnosis
Full details
Tests to consider
- CBC
- basic metabolic panel
- serum LFTs
- 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
- urine culture
- serum amylase and lipase
- abdominal ultrasound
- renal ultrasound
- cranial CT or MRI
Full details
Treatment algorithm
ACUTE
without volume depletion
without volume depletion but failed conservative management
with volume depletion
Contributors
Authors
Jeffrey D. Quinlan, MD, FAAFP
Professor and Chair
Family Medicine
Carver College of Medicine
University of Iowa
Iowa City
IA
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 information
Morning sickness
Morning sickness: questions to ask your doctor
More Patient information- Log in or subscribe to access all of BMJ Best Practice
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