Understanding Hyperemesis

• Diagnosis
  • Signs & Symptoms
  • Laboratory Findings
  • Risk Factors
  • Other Causes of NVP to Rule Out
  • Severity of Weightloss Calculator

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Lab Findings

Laboratory findings at the time of presentation include:

• Signs of dehydration and starvation such as increased ketones, increased urine specific gravity, increased blood urea nitrogen
• Electrolyte imbalances such as abnormal levels of sodium and potassium
• Increase in liver enzymes, such as in aspartate aminotransferase, alanine aminotransferase or bilirubin activity
• Abnormal thyroid and parathyroid levels
• Increased hematocrit, indicating a contracted blood volume

Electrolyte changes include decreased sodium, potassium, chloride and magnesium levels. However, in some women, lab levels such as electrolytes may appear falsely concentrated due to dehydration. Treatment for these women is advisable to replace marginally normal levels of electrolytes and nutrients. In general, whenever IV fluids are given for dehydration in hyperemetic women, parenteral vitamins and electrolytes should also be administered.

If the woman has been unable to eat sufficiently for a few weeks and has also been vomiting, she is at high-risk for nutritional deficiencies. Being pregnant, she is also in a state of accelerated starvation, meaning the adverse effects of starvation will occur more quickly. Significant malnutrition can occur in these women over time. Many nutrients are depleted in a relatively short time frame, especially water-soluble vitamins, such as thiamine. Thiamine deficiency has been well-documented in hyperemetic women and may lead to Wernicke's encephalopathy (an inflammatory, hemorrhagic form of encephalopathy). The prognosis is then poor as irreversible neurological damage and even death may occur.

Fortunately, most women with less severe HG or those who are treated aggressively early in pregnancy, will not have life-threatening complications or a prolonged recovery.

Identifying women at risk for developing HG is helpful so baseline laboratory tests can be done prior to onset of severe symptoms.

Adapted from US Pharmacist and other sources.

Updated on: Aug. 09, 2006