Nausea, vomiting and there may be ptyalism (excessive salivation).
Normally from 6-16 weeks, maximum 8-12 weeks.
Severity correlated to hCG and biochemical hyperthyroidism. Weight loss > 5%.
Prefunderance of femal fetures. Conflicting evidence of the role of helicobacter pyleri Dehydration with hyponatremia, < 120 mmol can cause seizures, spastic parous and extremely seldom respiratory failure (osmotic demyelinisation syndrome).
Hypokalemia. Metabolic hypochloremic alkalosis. Low serum urea.
Vitamin deficiencies, B12 and B6.
Mallory-Weiss tears of the esophagus and episodes of hematemesis.
Ketonuria.
Abnormal liver function test in severe cases.
Abnormal thyroid function test: Increase T4 and decrease TSH but clinically euthyroid (no thyroid antibodies).T4 levels normal by 15 weeks, TSH levels remained suppressed for a longer period.
Lack of Vitamin B1 (Thiamine) can cause Werniche's encephalopathy (40% fetal loss) with abnormal ocular movements, double vision ataxsia and/or confusion, in severe cases Werniche-Korsakoff's Syndrom psychosis (only 50% is cured).

Is a diagnose of exclusion.
Other causes are most common: Urinary tract infection, peptic ulcer, pancreatitis and more rarely Addison's disease.

Intravenous fluid:
Normal saline and potassium chloride is added to the infusion bags as required (no glucose infusion)
Pyridoxin-B6 10-25 mg 3 times a day
Antihistamine
H1 receptor antagonists (Promethazine 25 mg 2-3 times a day). Dopamine antagonists
Phenothiazines
Metoclopramid
should not be used for long period as it can cause dystonia.
Serotenin 5-HT3 antagonist: Ondansetron (Zofran) 5-hydroxytryptamin receptor antagonist 8 mg 2-3 x daily or intravenous 10 mg 3 x daily, only few studies.
Ginger 250 mg 4 times a day is more effective than placebo, but the use has recently been quistioned because of lack of evidence that Ginger is harmless in high dosis.
Corticosteroid
Methylprednisolone 16 mg 3 times a day (dose reduced by half every 3rd day), if tablet is not tolerated, hydrocortisone intravenously 100 mg BID.
Parenteral nutrition and/or enteral feeding.
Acupuncture -in PC6 and ST36mid seems very effective.
Prevention of Werniche's encephalopathy: Thiamine 50 mg 3 times a day. For severe cases intravenous treatment is required, Thiamine 100 mg diluted in 100 ml of normal saline and infused over 30-60 minutes.

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