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Hyperemesis Gravidarum in Emergency Medicine Workup

  • Author: Susan Renee Wilcox, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
 
Updated: Jan 08, 2016
 

Approach Considerations

Laboratory studies

Laboratory testing may include the following:

  • Obtaining electrolyte, BUN and creatinine, and serum ketone levels.
  • Measuring urine gravity and ketones.
  • Performing liver function tests (LFTs) if hepatitis is a concern. Of note, LFTs can be slightly elevated with hyperemesis gravidarum.
  • Performing a complete blood count and urinalysis to rule out other causes, with particular concern for pyelonephritis.
  • Obtaining serum amylase-to-creatinine ratio and/or lipase level if pancreatitis is a concern.

Note the following:

  • Hyperthyroidism causing nausea and vomiting is rare; a T3 and T4 level should be drawn if this is a concern. (Thyroid-stimulating hormone [TSH] can be suppressed in hyperemesis gravidarum.)
  • Serum hCG levels are not clinically useful in a patient with a known intrauterine pregnancy (IUP) and hyperemesis.

Imaging studies

The patient should have an ultrasonographic evaluation of her pregnancy to look for molar pregnancy or multiple gestations.

 
 
Contributor Information and Disclosures
Author

Susan Renee Wilcox, MD Instructor, Harvard Medical School; Critical Care Fellow, Department of Anesthesia and Critical Care and Pain Medicine, Department of Emergency Medicine, Massachusetts General Hospital

Susan Renee Wilcox, MD is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Zwanger, MD, MBA Assistant Professor, Department of Emergency Medicine, Jefferson Medical College of Thomas Jefferson University

Mark Zwanger, MD, MBA is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Chief Editor

Jeter (Jay) Pritchard Taylor, III, MD Assistant Professor, Department of Surgery, University of South Carolina School of Medicine; Attending Physician, Clinical Instructor, Compliance Officer, Department of Emergency Medicine, Palmetto Richland Hospital

Jeter (Jay) Pritchard Taylor, III, MD is a member of the following medical societies: American Academy of Emergency Medicine, South Carolina Medical Association, Columbia Medical Society, South Carolina College of Emergency Physicians, American College of Emergency Physicians, American Medical Association, Society for Academic Emergency Medicine

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Chief Editor for Medscape.

Additional Contributors

Assaad J Sayah, MD, FACEP Chief, Department of Emergency Medicine; Senior Vice President, Primary and Emergency Care, Cambridge Health Alliance

Assaad J Sayah, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Massachusetts Medical Society, National Association of EMS Physicians

Disclosure: Nothing to disclose.

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