Medically reviewed by Chris Schwerdt. Last updated on July 10, 2025
General Illness Information
Common Name:
Morning Sickness (Severe)
Medical Term: Hyperemesis gravidarum
Description:
- Persistent severe nausea and vomiting in a pregnancy;
- This may lead to dehydration and drastic changes in body chemistry;
- This is different from, and much more serious than, morning sickness during pregnancy.
Causes: Unknown.
- May be psychological factors;
- Hyperthyroidism;
- Hyperparathyroidism;
- Gestational hormones;
- Liver dysfunction;
- Autonomic nervous system dysfunction.
Prevention:
- Don’t use any drugs, including non-prescription drugs or alcohol, during pregnancy without medical advice;
- Maintain an adequate diet during all stages of pregnancy.
Signs & Symptoms
- Hypersensitivity to smell;
- Alteration in taste;
- Nausea;
- Vomiting with retching;
- Acidosis;
- Decreased urine output;
- Volume depletion;
- Fatigue;
- Starvation.
Risk Factors
- Altered gastrointestinal function;
- Various odors;
- Taste or sight of food;
- Hyperthyroidism;
- Hyperparathyroidism;
- Obesity;
- Multiple pregnancies;
- Nulliparity;
- Liver dysfunction.
Diagnosis & Treatment
- Electrolytes decreased;
- Urinalysis – glycosuria, albuminuria, granular casts and hematuria;
- Increased uric acid;
- Reduced protein in blood;
- There is no specific test for the diagnosis of Hyperemesis.
General Measures:
- Patient reassurance;
- Bed rest;
- If dehydrated, IV fluids.
Repeat if there is a recurrence of symptoms following initial improvement.
Medications:
- Pyridoxine 10-30 mg daily IV. Not always effective, but not harmful;
- Antihistamines (e.g., diphenhydramine or dimenhydrinate, or doxylamine);
- Phenothiazines (e.g., promethazine or prochlorperazine);
- Meclizine;
- Methylprednisolone.
Activity:
As tolerated, if ambulant.
Diet:
- Nothing by mouth for first 24 hours if patient is ill enough to require hospitalization;
- For outpatient: A diet rich in carbohydrates and protein, such as fruit, cheese, cottage cheese, eggs, beef, poultry, vegetables, toast, crackers, rice. Limit intake of butter;
- Patients should avoid spicy meals and high fat foods.
Possible Complications:
- Patients with greater than a 5% weight loss are associated with intrauterine growth retardation and fetal anomalies;
- Hemorrhagic retinitis;
- Liver damage;
- Central nervous system deterioration, sometimes leading to coma.
Prognosis
- Self-limited illness with good prognosis if patient’s weight is maintained at greater than 95% of the pre-pregnancy weight;
- With complication of hemorrhagic retinitis, mortality rate is 50%.
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