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Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Hyperemesis Gravidarum

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In one line

·The mom throws up so much during pregnancy that she loses weight and her body chemistry goes haywire.

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Normal physiology

·In a healthy early pregnancy, the placenta (the disk of tissue linking mom and baby) makes hCG (human chorionic gonadotropin) and estrogen to help the baby grow and the uterus stay thick and nourished. These hormones peak around 9 to 12 weeks, then drop. They also tickle the brainstem's vomiting center — a tiny cluster of nerve cells in the medulla (the lowest part of the brain, right above the spinal cord) — causing mild nausea or occasional vomiting in about 70 to 80% of pregnant people. That's normal morning sickness, and it usually fades by 14 to 16 weeks as hormone levels settle.

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What goes wrong

·In hyperemesis gravidarum, the mom's brainstem vomiting center reacts way too hard to pregnancy hormones — like an alarm that won't turn off — so she vomits constantly and can't keep food or water down.

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Hallmark signs

·Severe nausea and vomiting that won't stop (far worse than typical morning sickness)
·Not enough water in the body (dehydration) — dry mouth, dizziness, dark urine, feeling very weak
·Ketones in the urine (ketonuria)
·Body salts out of balance (electrolyte imbalance) — low potassium, low sodium, or low chloride in the blood
·Weight loss — dropping more than 5 percent of body weight from before pregnancy
·Fast heart rate (tachycardia) and low blood pressure
·Very tired and weak, trouble standing or walking
·Increased saliva (ptyalism)

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Red flags · escalate now

·Cannot keep down any food or liquid for 24 hours or longer
·Blood in vomit or vomit that looks like coffee grounds (a sign of bleeding in the stomach or esophagus)
·Severe belly pain (not just nausea) or fever over 100.4°F
·Confusion, slurred speech, or severe headache (signs of dangerously low sodium or severe dehydration hitting the brain)
·No urine for many hours or urine that is very dark and scanty (a warning that the kidneys are struggling)

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Workup

·Basic metabolic panel (BMP or Chem-7)
·Urinalysis with ketones
·Thyroid-stimulating hormone (TSH) and free T4
·Complete blood count (CBC)
·Liver function tests (AST, ALT, bilirubin)
·Ultrasound of the uterus

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Treatment

·Thiamine 100 mg IV or IM before giving any dextrose
·IV fluids (normal saline or lactated Ringer solution) with dextrose added after thiamine is given
·Pyridoxine (vitamin B6) 10 to 25 mg three to four times daily plus doxylamine 12.5 mg three to four times daily
·Ondansetron 4 to 8 mg IV or by mouth every 8 hours if pyridoxine-doxylamine is not enough
·Metoclopramide 10 mg IV or by mouth every 6 to 8 hours if ondansetron fails or is not safe
·Correct electrolytes — add potassium chloride and sodium chloride to IV fluids as needed to bring levels back to normal
·Enteral nutrition by nasogastric or nasojejunal tube, or total parenteral nutrition (TPN) through a central IV line, if vomiting continues and weight loss goes on for more than one week despite treatment

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NCLEX trap

·ALWAYS give thiamine (vitamin B1) first, before any dextrose, in hyperemesis gravidarum. If you give dextrose without thiamine, you can trigger Wernicke encephalopathy — a sudden brain injury that damages the thalamus (the brain's relay station) and cerebellum (the balance center). Thiamine is the shield that protects the brain; dextrose is the fuel. Shield first, then fuel.
·Morning sickness is common nausea and occasional vomiting in early pregnancy — uncomfortable but does not make the mom lose weight or dry out. Hyperemesis gravidarum is severe, constant vomiting that causes weight loss over 5%, dehydration, and dangerously low electrolytes (sodium, potassium, chloride). They are completely different problems that need completely different treatment. Morning sickness gets crackers and ginger; hyperemesis gravidarum gets IV fluids, thiamine, and hospital-grade antiemetics.
·In hyperemesis gravidarum, make the patient safe first (IV fluids with thiamine to protect the brain and refill the tank), figure out what is broken second (blood tests for sodium, potassium, chloride, bicarbonate, and urine ketones), then fix it the right way third (balanced IV fluids, electrolyte replacement, antiemetics, and nutrition support). Always: safe, then diagnose, then treat. You cannot fix electrolytes without fixing the dehydration that is washing them out.
·Hyperemesis gravidarum that causes weight loss over 5%, low blood pressure, fast heart rate, and electrolyte imbalances is a medical emergency. She needs IV fluids, thiamine 100 mg IV before any dextrose, antiemetics (ondansetron, metoclopramide, or promethazine), electrolyte replacement, and possibly hospital admission. Home remedies alone will not save her or the baby. Ginger and peppermint are fine for mild morning sickness, not for hyperemesis gravidarum.
·The PUQE score (Pregnancy-Unique Quantification of Vomiting (Emesis)) measures how bad the vomiting is — it counts how many times she threw up, how long she felt nauseated, and how many times she retched. It does NOT diagnose hyperemesis gravidarum. Diagnosis is clinical: severe vomiting in early pregnancy (usually before 12 weeks) with weight loss over 5%, dehydration, and electrolyte abnormalities. The PUQE score helps you track how sick she is and whether treatment is working.

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