Hyperemesis Gravidarum (HG) is defined as a potentially life-threatening pregnancy disease that may cause weight loss, malnutrition, dehydration, and debility due to severe nausea and/or vomiting, and may cause long-term health issues for mother and baby(ies).

The 5 D’s of dehydration

  • Dry mouth and lips, thirst
  • Dark/decreased urine
  • Dizziness and/or headache
  • Despair and depression
  • Delirium and confusion

If she has several of these symptoms and it is after working hours, it may be necessary to go to the ER or an urgent care center.

If a patient cannot keep more than a few bites of food or a few sips of water down for 24 hours or more, loses 2 or more pounds (0.9 kg) in one week, vomits blood, faints, or generally feels very unwell, call the doctor. 

Vitamins, especially thiamin, are important if there is dehydration in pregnancy

After vomiting for 2-3 weeks and eating very little, women need IV vitamins including a multivitamin (MVI) and B complex (or at least thiamin). Make sure to ask about it, it is very important! B vitamins become most critical as they are depleted rapidly, especially in the presence of a high carbohydrate (e.g. sugar) diet, and come from foods not often craved during pregnancy.

HER HG Treatment Protocol

Ketones in urine indicate starvation

If a patient has ketones in her urine (the test is positive), fluids with vitamins are usually needed through an intravenous (IV) line. Fluids can be administered at a doctor’s office, ER, hospital, or an urgent care center. Consider nutritional therapy if ketones recur. Patients can monitored with Ketostix from a local pharmacy with a prescription. These test for starvation, or lack of carbohydrates, but are not reliable to diagnose HG. They are simply an indicator that a woman needs more calories. Ketones may be harmful to the baby if not treated.

***Remember, dehydration, vitamin deficiencies (esp. thiamin/B1), and ketones worsen nausea and vomiting and need to be closely monitored when mothers are very ill.

Call a health professional if any of the following occur

  • Abdominal pain, bleeding, or cramping
  • Difficulty thinking or focusing
  • Difficulty walking or talking
  • Extreme fatigue and very low energy
  • Little if any food or fluids stay down for 24+ hours
  • Little saliva and a dry mouth
  • Moderate or severe headache and/or fever
  • Muscular weakness or severe cramping
  • Repeated vomiting or retching daily
  • Severe nausea prevents eating for 2+ days
  • Shortness of breath or dizziness
  • Urination is infrequent (≤ 3 times/day) and minimal amount
  • Urine is dark yellow and concentrated
  • Visual disturbances, BLURRED VISION, or fainting
  • Vomit is bright red with blood (or looks like coffee grounds)
  • Loss of 2 pounds (0.9 kg) or more in a week
  • Her HELP Score is increasing (doctors may not be aware of this new tool)
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