Hyponatraemia In Pre-eclampsia – Rare But Easily Missed

1. Hyponatraemia In Pre-eclampsia – Rare But Easily Missed Quazi Selina Naquib, Sivarajini Sivarajasingam, Gurbaksh Badial, Dilip Visvanathan, Manish Gupta Whipps Cross University Hospital, Barts NHS Trust Background Case History level on Day 1 of 131 and later that day 133 mmol/l. The maternal sodium level returned to normal by the tenth postnatal day. Hyponatraemia in pre-eclampsia is rare but must be picked up early and managed appropriately to prevent complications to both the mother and baby. Multidisciplinary management if required . Delivery of the fetus is the only definitive treatment in a worsening scenario. of 129, potassium of 4.9 mmols/l and a Urate level of 0.44. Platelet count and haematocrit were normal. An ultrasound of the kidney, ureter and bladder was normal. 2 weeks later the PCR was 686, with a sodium of 120 and potassium of 5.3 mmol/l. The blood pressure was 147/93 mmHg. An ECG was normal. Treatment with oral salts and 0.9% saline, and labetalol was commenced. There was no evidence of fluid overload clinically. A decision was taken to deliver by Caesarean section 2 days later as maternal sodium level fell to 118 mmol/l. The fetus had a breech presentation, and growth had tailed off with increased resistance in the umbilical artery doppler. The baby weighed 1.5 kg, with good APGARs and normal cord blood gases with sodium A 33 year old primigravidae booked at 9 weeks with a normal blood pressure (BP) and urine analysis. She had a 1:8 risk of Down’s syndrome on quadruple serum screening but declined invasive testing. Fetal growth surveillance by ultrasound was arranged. She attended regular antenatal checks which were uneventful. At 30 weeks and 6 days gestation, a blood pressure of 140/80 mm Hg with 2 plus proteinuria (PCR 135) was noted. Her blood screen for pre-eclampsia was normal. 24 hour urine collection showed a total protein of 0.7g, PCR of 142 . She was admitted at 32 weeks and 4 days gestation with headache, a BP of 132/80 mm Hg and 3 plus proteinuria. Ultrasound revealed a growth restricted fetus with cerebral redistribution. Her serum biochemistry showed a sodium Hyponatraemia in pre-eclampsia is a rare but potentially fatal complication. Maternal symptoms include headache, lethargy, nausea, drowsiness, muscle cramps, confusion, convulsions and coma. Death can occur in up to 50% of cases if the serum sodium falls below 120 mmol/l. Fetal and neonatal hyponatraemia as a consequence can cause polyhydramnios, jaundice and tachypnoea of the newborn. Neonatal seizures can occur if serum sodium levels fall below 130 mmol/l. Maternal symptoms can easily be mistaken for pre-eclampsia and even eclampsia. A literature review from 1998- 2011 revealed 9 case reports. We are reporting the 10th from our hospital in 2011 to remind obstetricians of the need to be aware of this complication and manage it appropriately. Conclusions . References 1 . A Tarik et E Ward . Severe Hyponatremia in pregnancy associated with pre-eclampsia . Society for Endocrinology BES 2011 2. G Sandhu et all . Pathophysiology and management of preeclampsia – associated severe hyponatremia . Am J of Kidney Diseases , 2010 3 . A Linton & A Gale . Severe hyponatremia associated with preeclampsia . J of Obstet and Gynaecology , 2009 4 . Decaux G , Musch W . Clinical laboratory evaluation of the syndrome of inappropriate secretion of antidiuretic hormone . Clin J Am Soc Nephro logy , 2008 5. Ravid et all . Hyponatremia and preeclampsia . J Maternal Fetal Neonatal Med , 2005 6 . Celia B , Michael de S . Severe hyponatremia and preeclampsia . BJOG , 2004 7 . Magriples et all . Dilutional hyponatremia in preeclampsia with and Without nephrotic syndrome . Am J Obstet Gynae , 2001 7. John P Hayslett et all . Dilutional hyponaremia in preeclampsia . Amrican J Obstet Gyn , 1998 Objective