Hyperemesis Gravidarum in Emergency Medicine Workup

Updated: Feb 04, 2021
  • Author: Feras H Khan, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Workup

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.