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Abstract: SA-PO713

Running Dry: The Thirsty Journey of Postpartum Diabetes Insipidus

Session Information

Category: Fluid, Electrolytes, and Acid-Base Disorders

  • 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Rivera Rios, Jeaneishka Marie, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Ocasio Melendez, Ileana E., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Andujar-Rivera, Krystahl Z., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Pacheco-Molina, Caleb Samuel, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Rivera-Bermudez, Carlos G., Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Vega-Colon, Jesus Daniel, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
  • Rivera, Maria Eugenia, Universidad de Puerto Rico Escuela de Medicina, San Juan, Puerto Rico
Introduction

Diabetes insipidus (DI) is a rare complication of pregnancy, occurring in 1 in 30,000 pregnancies. During pregnancy or the postpartum period, DI can be associated with excessive vasopressinase activity secreted by the placental trophoblasts, which increases the degradation rate of vasopressin.

Case Description

A 28-year-old female G2P1A0 with a trichorionic triamniotic pregnancy at 27 3/7 weeks gestation, was admitted to the hospital due to preterm premature rupture of membranes (PPROM) and later developed preeclampsia. After an emergent cesarean section, she developed acute respiratory distress syndrome requiring endotracheal intubation, was treated for hyperthyroidism and transfused with one packed red blood cells. On day 6 following delivery, the patient developed polyuria, no polydipsia reported while sedated on mechanical ventilation. Laboratory investigations showed normoglycemia, normocalcemia, hypokalemia, hypomagnesemia, hypernatremia (serum sodium level of 151 mEq/L), a urine output of 6.5 L/day, and a urine specific gravity of 1.005. Total placenta weight was found to be 770 g (normal 500-600 g in a full-term pregnancy). Treatment with synthetic analogue 1-deamino-8-D-arginine vasopressin resulted in decreased urine output, increased urinary osmolality, and normalization of sodium levels. The patient was discharged from the hospital with no signs of DI or additional complications. Endocrinological follow-up confirmed that there were no underlying metabolic disorders.

Discussion

This case highlights the diagnostic complexity of transient diabetes insipidus in the postpartum period. It is a rare complication that can occur following pregnancy and delivery, especially in patients with pre-existing medical conditions. Diagnosing DI during pregnancy can be challenging due to physiological changes, which can make interpreting results difficult. A high index of suspicion for vasopressinase-induced DI should be considered in the presence of risk factors such as preeclampsia, hepatic dysfunction, and multiple gestation.