- Severe nausea and vomiting.
- Food aversions.
- Weight loss of 5% or more of pre-pregnancy weight.
- Decrease in urination.
- Extreme fatigue.
- Low blood pressure.
- Rapid heart rate.
- Loss of skin elasticity.
- Secondary anxiety/depression.
- Urinalysis for ketones and specific gravity: A sign of starvation, ketones may be harmful to fetal development. High specific gravity occurs with volume depletion.
- Serum electrolytes and ketones: Assess electrolyte status to evaluate for low potassium or sodium, identify hyperchloremic metabolic alkalosis or acidosis, and evaluate renal function and volume status.
- Liver enzymes and bilirubin: Elevated transaminase levels may occur in as many as 50% of patients with hyperemesis gravidarum. Mild transaminitis often resolves once the nausea has resolved. Significantly elevated liver enzymes, however, may be a sign of another underlying liver condition, such as hepatitis (viral, ischemic, autoimmune), or some other etiology of liver injury.
- Amylase/lipase: Amylase level is elevated in approximately 10% of patients with hyperemesis gravidarum. Lipase, when combined with amylase, can increase the specificity in diagnosing pancreatitis as an etiology.
- TSH, free thyroxine: Hyperemesis gravidarum is often associated with a transient hyperthyroidism and suppressed TSH levels in 50-60% of cases. However, an elevated free thyroxine may suggest that overt hyperthyroidism is present, thus necessitating further workup and treatment.
- Urine culture: This may be indicated because urinary tract infection is common in pregnancy and can be associated with nausea and vomiting.
- Calcium level: Consider measuring Ca++ levels. Some rare cases have been reported of hypercalcemia being associated with hyperemesis gravidarum, resulting from hyperparathyroidism.
- Hematocrit: This may be elevated because of volume contraction.
- Hepatitis panel: If clinically indicated, hepatitis A, B, or C may be confused with hyperemesis gravidarum.
- Obstetric ultrasonography is usually warranted in patients with HEG to evaluate for multiple gestations or trophoblastic disease.
- Additional imaging studies generally are not needed unless the clinical presentation is atypical (eg, nausea and/or vomiting beginning after 9-10 wk of gestation, nausea and/or vomiting persisting after 20-22 wk, acute severe exacerbation) or another disorder is suggested based on history or physical examination findings.
- If indicated clinically, performing upper abdominal ultrasonography to evaluate the pancreas and/or biliary tree appears to be a low-risk study.
- In rare cases, abdominal CT scan or even MRI may be indicated if appendicitis is under consideration as a cause of nausea and vomiting in pregnancy.
- Nasogastric - restores nutrients through a tube passing through the nose and to the stomach.
- Percutaneous endoscopic gastrostomy - restores nutrients through a tube passing through the abdomen and to the stomach; requires a surgical procedure.
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