Differential diagnosis is extensive
for women who first experience nausea
and vomiting after 9 weeks’ gestation,
as seen in Table 1 of Practice
Bulletin 153.3 History predating the
pregnancy is important especially for
the gastrointestinal conditions cholelithiasis
or peptic ulcer disease, or metabolic
endocrine conditions involving
the thyroid or parathyroid, or diabetes.
Symptoms of fever or abdominal
pain should also prompt an investigation
for other causes in the differential
because neither are typical features
of hyperemesis. Abnormal laboratory
findings in hyperemesis can include
mildly elevated liver transaminase and
bilirubin, elevated amylase, and suppressed
thyroid stimulating hormone
(TSH) levels.
.