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Kidney Week

Abstract: FR-PO587

Evaluating Preeclampsia as a Rare Cause of Severe Hyponatremia

Session Information

  • Trainee Case Reports - III
    October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Trainee Case Reports

  • 902 Fluid and Electrolytes: Clinical

Authors

  • De, Shreemayee, Newark Beth Israel Medical Center, Edison, New Jersey, United States
  • Liaqat, Aimen, Saint Barnabas Medical Center , West Orange, New Jersey, United States
Introduction

During normal pregnancy, resetting of osmostat can take place resulting in decrease of plasma osmolality by about 10 mOsm/kg, and mild decrease in serum sodium concentration by 4-5 meq/L. This phenomenon has been associated with increased production of hCG. Preeclampsia is a multisystem disorder defined by hypertension and proteinuria, but not classically associated with severe hyponatremia. However, there are rare incidences where severe hyponatremia is a complication of preeclampsia that can result in serious complications such as convulsions and cerebral edema.

Case Description

The first case is about a 32-year old female of 27-week gestation who presented with preeclampsia with severe features. Due to worsening epigastric pain, HELLP syndrome and elevated blood pressure, patient had emergent C-section at 28-week gestation. Patient was also found to have severe hyponatremia with lowest serum sodium concentration of 120 meq/L on the day of C-section. She was initially treated with fluid restriction and diuretics; this resulted in overcorrection of sodium by 10 meq/L that was treated with hypotonic fluid and one dose of desmopressin. Gradually the correction of sodium slowed down and eventually corrected to 142 meq/L on the day of discharge. The second case is about a 29-year old female of 33-week gestation who also presented with preeclampsia with severe features. Due to breech presentation of the fetus and preeclampsia, patient had C-section at 34-week gestation. Patient initially had normal serum sodium concentration. Overtime sodium concentration decreased to 126 meq/L one day prior to C-section. Gradually, sodium improved appropriately with diuretics and fluid restriction to 136 meq/L 2 days after C-section.

Discussion

The pathogenesis of preeclampsia associated severe hyponatremia has been widely postulated. It is important to understand the etiology of severe hyponatremia based on history and physical exam, which can help guide treatment. The main mechanism is yet to be understood. There is a theory that preeclampsia can stimulate non-osmotic release of ADH. Another theory suggests that defective placenta in preeclamptic patients is unable to produce enough vasopressinase that would rapidly inactivate ADH. Although the incidence of preeclampsia associated severe hyponatremia is reported rarely, it is a serious complication that needs to be addressed soon and managed promptly.