Nausea and vomiting of pregnancy (NVP) is a common complaint encountered by emergency providers, especially for women in their first trimester of pregnancy. Up to 85% of pregnant women will experience these symptoms, with 0.3% to 2% of patients presenting with the more severe condition of hyperemesis gravidarum (HG). There is no single accepted definition of HG, but it is considered to be a diagnosis of exclusion based on persistent nausea and vomiting associated with measures of acute starvation such as ketosis, more than 5% weight loss, or hospitalization in the absence of other diseases.1,2
Although NVP is associated with a reduced risk for pregnancy loss, HG is the most common reason for hospitalization during the first half of pregnancy and is associated with increased risk of maternal morbidity and adverse birth outcomes such as anemia, preeclampsia, eclampsia, venous thromboembolism, preterm delivery, and delivery by cesarean section.3,4
Severe untreated cases of HG can lead to Wernicke encephalopathy, central pontine myelinolysis, esophageal rupture, pneumothorax, as well as hepatic and renal impairment.5
The emergency department (ED) management of these patients focuses on evaluating for other causes of these symptoms and providing appropriate treatment modalities.