Back to Basics: Hyperemesis Gravidarum

Hyperemesis Gravidarum


Intractable vomiting of pregnancy with:

  • Weight loss > 5%
  • Ketonuria
  • Hypokalemia
  • Volume depletion

Work-up and Management:


  • UA, Upreg → for ketonuria
  • Chem7, Mg → for hypochloremic, hypokalemic metabolic alkalosis

Medical Management

  • Lifestyle modifications → avoid triggers + small meals + ginger ale
  • B6 + Doxylamine aka Diclegis
  • D5NS with low threshold to add thiamine to avoid Wernicke’s
  • Promethazine v. Reglan v. Zofran if refractory

Risk Management Strategies/ Pitfalls:

  • Hyperemesis gravidarum and morning sickness should be a diagnosis of exclusion in the pregnant vomiting patient.
  • Abdominal pain is highly unusual and should prompt a broad differential. Don’t forget about surgical etiologies like appendicitis and ovarian torsion
  • Broaden the differential diagnosis when there is increase in vomiting at 9+ weeks



Goodwin TM. Hyperemesis gravidarum. Obstet Gynecol Clin North Am 2008;35(3):401–417 [PubMed: 18760227].