**2.1.1 Hyperemesis gravidarum**

Severe vomiting in early pregnancy can lead to volume depletion and acute kidney injury. Metabolic alkalosis can be seen. Vomiting can be aggravated by certain triggers which include strong smells, postures which delay gastric emptying, hot foods etc. The patient may need hospitalization and volume replacement. Antiemetic drugs can be used to control vomiting. These include pyridoxine-doxylamine succinate combination therapy for initial pharmacologic treatment of nausea of pregnancy, antihistaminics, domperidone, metaclopramide, and ondensetron. Glucocorticoids have been used in refractory cases. Hyperemesis may recur in subsequent pregnancies. (ACOG, 2004)
