Hyponatraemia compounding pre-eclamptic toxaemia in a patient with type 1 diabetes.
diabetes
endocrinology
obstetrics and gynaecology
Journal
BMJ case reports
ISSN: 1757-790X
Titre abrégé: BMJ Case Rep
Pays: England
ID NLM: 101526291
Informations de publication
Date de publication:
02 Sep 2020
02 Sep 2020
Historique:
entrez:
4
9
2020
pubmed:
4
9
2020
medline:
23
2
2021
Statut:
epublish
Résumé
We report a case of profound, symptomatic hyponatraemia in association with pre-eclamptic toxaemia (PET) in a 38-year-old nulliparous woman with type 1 diabetes mellitus. This patient developed hypertension and proteinuria at 31+6 weeks' gestation and was admitted for management of pre-eclampsia. Severe headache, visual disturbance and nausea were associated with a hyponatraemia of 115 mmol/L followed by ketoacidosis. This was reversed through fluid restriction, supplementation with 1.8%-3.0% hypertonic saline and a volume-reduced variable-rate insulin infusion. Clinical stability was achieved and she was subsequently worked up for an induction of labour for worsening pre-eclampsia. Hyponatraemia in the context of PET has been previously reported as rare. However, it has complications that may significantly compound the sequelae of severe PET. We propose that specific and focused monitoring of serum sodium levels should become common practice in the management of women with this condition to allow for timely, measured correction of abnormalities.
Identifiants
pubmed: 32878836
pii: 13/9/e236511
doi: 10.1136/bcr-2020-236511
pmc: PMC7470496
pii:
doi:
Substances chimiques
Insulin
0
Saline Solution, Hypertonic
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© BMJ Publishing Group Limited 2020. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Int J Obstet Anesth. 2007 Oct;16(4):360-2
pubmed: 17643289
Am J Kidney Dis. 2010 Mar;55(3):599-603
pubmed: 20005030
Gynecol Endocrinol. 2013 Aug;29(8):801-3
pubmed: 23706139
Intern Med J. 2015 Feb;45(2):195-202
pubmed: 25370908
J Matern Fetal Neonatal Med. 2005 Jul;18(1):77-9
pubmed: 16105796
Cochrane Database Syst Rev. 2017 Mar 21;3:CD004454
pubmed: 28321847
BJOG. 2004 Sep;111(9):1020-2
pubmed: 15327622
Platelets. 1994;5(2):90-5
pubmed: 21043609
Curr Neurol Neurosci Rep. 2015 Apr;15(4):18
pubmed: 25724319
Eur J Endocrinol. 2014 Feb 25;170(3):G1-47
pubmed: 24569125
Med Hypotheses. 1990 Apr;31(4):283-7
pubmed: 2192237
N Engl J Med. 1970 Jan 8;282(2):88-9
pubmed: 5409500
Immun Ageing. 2008 Nov 12;5:14
pubmed: 19014475
Am J Obstet Gynecol. 2001 Jan;184(2):231-2
pubmed: 11174509
BMJ Open. 2016 Jan 25;6(1):e009494
pubmed: 26810997
Diabetologia. 1981 Sep;21(3):165-71
pubmed: 7028550
World J Clin Cases. 2014 Oct 16;2(10):488-96
pubmed: 25325058
Lancet. 2016 Mar 5;387(10022):999-1011
pubmed: 26342729
Eur J Clin Invest. 2015 Aug;45(8):888-94
pubmed: 25995119
Lancet Glob Health. 2014 Jun;2(6):e323-33
pubmed: 25103301
Clin Nephrol. 2009 Dec;72(6):492-6
pubmed: 19954728
Am J Physiol. 1984 Jan;246(1 Pt 2):F105-9
pubmed: 6696073
Am J Obstet Gynecol. 1998 Nov;179(5):1312-6
pubmed: 9822522
Am J Obstet Gynecol. 1987 Apr;156(4):910-1
pubmed: 3578399
A A Pract. 2019 Apr 15;12(8):261-263
pubmed: 30277898
J Obstet Gynaecol. 2006 Oct;26(7):695-6
pubmed: 17071447
J Perinat Med. 2017 May 24;45(4):467-470
pubmed: 27442355
J Matern Fetal Neonatal Med. 2018 Jul;31(14):1948-1949
pubmed: 28514932
BMJ. 2019 Jul 15;366:l2381
pubmed: 31307997
J Obstet Gynaecol. 2009 Feb;29(2):143-4
pubmed: 19274550
BMJ Case Rep. 2016 Aug 24;2016:
pubmed: 27558187
Am J Med. 1987 Nov;83(5):905-8
pubmed: 3674097
BJOG. 2009 Mar;116(4):552-61
pubmed: 19175600
Diabet Med. 2011 May;28(5):508-15
pubmed: 21255074
Arch Dis Child Fetal Neonatal Ed. 1998 Mar;78(2):F81-4
pubmed: 9577274