Nausea and vomiting are common in pregnancy. Hyperemesis gravi- darum, however, is a much more serious and potentially fatal problem. Findings that should ale the physician to the diagnosis of hyperemesis gravidarum early in its course include

Hyperemesis gravi- darum is intractable vomiting of pregnancy and is associated with dis- turbed nutrition. Early signs of the disorder include weight loss (up to 5% of body weight) and ketonuria. Because vomiting causes potassium loss, electrocardiographic evidence of potassium depletion, such as inveed T waves and prolonged QT and PR intervals, is usually a later finding. Jaun- dice also is a later finding and is probably due to fatty infiltration of the liver; occasionally, acute hepatic necrosis occurs. Metabolic acidosis is rare. Hypokalemic nephropathy with isosthenuria may occur late. Hypopro- teinemia also may result, caused by poor diet as well as by albuminuria. Patients who have hyperemesis gravidarum are best treated (if the disease is early in its course) with parenteral fluids and electrolytes, sedation, rest, vitamins, and antiemetics if necessary. In some cases, isolation of the patient is necessary. Very slow reinstitution of oral feeding is permitted after dehydration and electrolyte disturbances are corrected. Therapeutic aboion may be necessary in rare instances; however, the disease usually improves spontaneously as pregnancy progresses.