Diagnosis of Hyperemesis Gravidarum in Patients with Pregnancy- Induced Vomiting Using a Point-of-Care Ketone Blood Test

Pregnancy-induced nausea and vomiting (PINV) is a common problem at the early stages of pregnancy. Approximately, 50%–80% of pregnant women who are in their first trimester are affected, resulting in loss of work time and negative effects on social and family relationships (1). Hyperemesis gravidarum (HG) affects approximately 2.5% of pregnant woman and is characterized by persistent vomiting, weight loss of more than 5%, dehydration, ketonuria, electrolyte abnormalities, acid–base imbalance, and sometimes hepatic and renal failure (2). Currently, there is no consensus on the definition of HG and there is no single, widely used set of diagnostic criteria for diagnosing HG at the emergency department (ED). There are commonly used diagnostic modalities with low sensitivity, such as clinical findings of patients, weight loss, dehydration, and/or electrolyte imbalance, and ketonuria (3). Urine ketone dipstick tests are used in the ED to screen for ketonuria in patients with PINV to detect metabolic derangements in the early phases. Although urine ketone dipsticks tests routinely measure urinary acetoacetate, they do not detect the ketone predominant in HG, which is β-hydoxybutyric acid (β-HBA). In the