Abstract: PUB365
A Very Thirsty Pregnant Patient with Polyuria: Rare Case of Gestational Diabetes Insipidus
Session Information
Category: Women's Health and Kidney Diseases
- 2200 Women's Health and Kidney Diseases
Authors
- Frangenberg, Alexander M, Methodist Dallas Medical Center, Dallas, Texas, United States
- Collazo-Maldonado, Roberto L., Methodist Dallas Medical Center, Dallas, Texas, United States
Group or Team Name
- Department of Nephrology.
Introduction
Gestational DI occurs during pregnancy, commonly in the third trimester, due to placental production of vasopressinase, an enzyme that degrades AVP. Patients with increased placental mass, such as multiple gestations, preeclampsia, or underlying hepatic dysfunction, vasopressinase activity may exceed the processing ability of the liver, resulting in transient DI. Serum and urine osmolarity are paramount for diagnosis and can be confirmed by the patient’s response to desmopressin or termination of pregnancy.
Case Description
18 yo G1 34w4 by 11 wk sono with no PMHx presented to admit to L&D for labor induction due to pre-e w/ SF with severe range BP requiring IV antihypertensives. Patient was thirsty, drinking 4-6 L of water per day with up to 9 L of urine output a day. Labs were pertinent for Urine osm 75, ALP 238, with normal Cr, BUN, and notably Na of 134, likely related to patient’s polydipsia. Nephrology was consulted after successful C-section with improvement of urine osm to 267. 1-deamino-8-D-arginine vasopressin (DDAVP) withheld as Na and kidney function remained stable after delivery
Discussion
This case highlights a rare but important presentation of gestational DI in pregnancy. The patient developed distinct polyuria and polydipsia upon admission at appx 34 weeks in the setting of pre-eclampsia with severe features, with labs confirming low urine osmolality. While desmopressin was considered, the patient’s Na and kidney function remained consistently stable post-delivery. This case adds to the limited body of literature on nephrogenic DI and highlights the need for clinical diligence among providers caring for polyuric and polydipsic pregnant patients.
Conclusion:
Native AVP is susceptible to vasopressinase breakdown, whereas desmopressin (DDAVP) is not, thus explaining the therapeutic efficacy of desmopressin for gestational DI.