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Kidney Week

Abstract: PO2602

Hyponatremia in Preeclampsia: A Diagnostic and Therapeutic Challenge

Session Information

Category: Trainee Case Report

  • 2000 Women’s Health and Kidney Diseases

Authors

  • Seif, Nay, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
  • Srivastava, Anand, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
Introduction

A 32-year-old female at 35-weeks gestation with twin pregnancy was admitted for hypertension, proteinuria, and hyponatremia (Figure 1A).

Case Description

She complained of nausea, blurred vision, and pain. Physical exam revealed 3+ generalized edema. Her blood pressure improved with conservative management, and medications controlled her nausea and pain. Figure 1B shows her hospital serum sodium trend. The physical exam, serum and urine studies suggested hypervolemic hyponatremia due to nephrotic syndrome. She was placed on fluid restriction. Repeat serum sodium and urine protein to creatinine ratio (UPCR) were 118 mEq/L and 4.4 g/g creatinine, respectively. Her obstetrician decided to perform emergency delivery. Prior to oxytocin induction, she received 3% saline, 0.9% saline, and IV furosemide. Three hours after delivery, serum sodium was 125 mEq/L and UPCR was 0.2 g/g creatinine. Fluid restriction continued for the first 24 hours after delivery and her serum sodium remained stable. Over the next 24 hours, her serum sodium corrected to 138 mEq/L with liberalization of the fluid restriction

Discussion

Hyponatremia in pregnancy may be due to antidiuretic hormone (ADH)-dependent factors, such as “reset” osmostat, diffuse vasodilation, nausea, and pain. Administration of oxytocin, which is structurally similar to ADH, can also reduce serum sodium. In preeclampsia, hyponatremia may occur due to decreased effective circulating volume secondary to antiangiogenic factors or nephrotic syndrome, non-osmotic release of ADH with consequent water retention, or SIADH. Worsening hypertension with end organ damage are severe features of preeclampsia often requiring emergent delivery, but severe hyponatremia is often overlooked as a severe feature. This case illustrates that patients with preeclampsia may develop severe hyponatremia, which improves after delivery. Refined guidelines should consider severe hyponatremia and its management in preeclampsia