Hyponatraemia and Brain Oedema in Newborns Following Oral Water Intoxication during Prolonged Labour

Walter, Karlie; Montgomery, J. E.; Amess, P; Rabe, Heike

doi:10.1055/s-0032-1306296

Cited by 7 publications

(5 citation statements)

References 8 publications

(9 reference statements)

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“…There still is a widespread belief in beneficial effects of abundant water intake, and two obstetric studies quite recent at the time of our study indicated shorter duration of labour following more abundant fluid administration (71,72). A subsequent Cochrane report could not support these findings (73), but cases of even severe hyponatraemia during labour are reported also in more recent years (6,111). Clearly, the potential dangers of exaggerated water intake has not spread to the…”

Section: Paper 2 Hyponatraemia During Labourmentioning

confidence: 57%

Feto-maternal osmotic balance at term. A prospective observational study

Moen

Brudin

Tjernberg

et al. 2018

Journal of Perinatal Medicine

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Section: Paper 2 Hyponatraemia During Labourmentioning

confidence: 57%

Feto-maternal osmotic balance at term. A prospective observational study

Moen

Brudin

Tjernberg

et al. 2018

Journal of Perinatal Medicine

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“…There remains a relative dearth of cases published in the literature, hence contributing to the difficulty in establishing its true incidence 11. Pregnancy presents a unique predisposition to hyponatraemia with physiological and hormonal changes in the first 8 weeks’ gestation that affect osmoregulation, a phenomenon known as ‘pregnancy-induced osmostat reset’ 8. It normally results in a decrease in plasma sodium concentration of 3–5 mmol/L that is stable throughout pregnancy.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, cases of dilutional hyponatraemia persist. In the last 20 years, there have been 15 reported cases among labouring women, with 11 cases of serious adverse neonatal events, including seizures and apnoea, all attributed to dilutional hyponatraemia 8 9. The majority of mothers were asymptomatic or showed only mild, non-specific symptoms 8.…”

Section: Introductionmentioning

confidence: 99%

“…In the last 20 years, there have been 15 reported cases among labouring women, with 11 cases of serious adverse neonatal events, including seizures and apnoea, all attributed to dilutional hyponatraemia 8 9. The majority of mothers were asymptomatic or showed only mild, non-specific symptoms 8. Other maternal signs and symptoms may include a headache, nausea, seizures and cerebral oedema.…”

Section: Introductionmentioning

confidence: 99%

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Severe pre-eclampsia as a rare cause of profound hyponatraemia

Dunphy,

Sadik,

Qureshi

et al. 2023

BMJ Case Rep

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Profound hyponatraemia, defined as sodium <125 mmol/L, is a very rare complication of pre-eclampsia (PET) with a relative paucity of cases reported. Pre-eclampsia is a multisystem disorder with a maternal mortality of up to 20%. Hyponatraemia is associated with disease severity, twin pregnancy, advanced maternal age, in vitro fertilisation and HELLP (haemolysis, elevated liver enzymes and low platelets). The authors present the case of a low-risk nulliparous woman presenting with frontal headache and normal BP at 31+2weeks gestation. Laboratory investigations confirmed a sodium of 123 mmol/L. Her urine protein creatinine ratio was 322 mg/mmol. She developed PET (BP 171/100 mm Hg) refractory to pharmacological management. She underwent an emergency lower segment caesarean section and was delivered of a live neonate. The maternal serum sodium normalised within 24 hours. Hyponatraemia should be regarded as a marker of severity in the setting of pre-eclampsia and may be an indication for an expedited delivery. Prompt management is required to prevent convulsions, maternal mortality and adverse fetal outcomes.

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“…Numerous case studies have also described mothers in labor with excessive fluid intake (3-4 L/day) resulting in newborns with clinically significant hyponatremia (<125 mEq/L; Chapman & Hamilton, 2008;Johansson, Lindow, Kapadia, & Norman, 2002;Ophir, Solt, Odeh, & Bornstein, 2007;Walter, Montgomery, Amess, & Rabe, 2012;West & Harding, 2004). These case studies demonstrate that when excess fluid input during labor exceeds the mother and fetus's ability to maintain sodium levels above 125 mEq/L, serious clinical symptoms occur and medical intervention is necessary.…”

Section: A New Modelmentioning

confidence: 99%

The Healthy Newborn Hydration Model

Mulder

Gardner

2014

Biological Research For Nursing

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The normal small volume of breast milk produced in the first 2 days following birth may raise concerns about adequate hydration in breast-fed newborns. These concerns are further magnified when breast-fed infants lose ≥7% of their birth weight within 2 days postnatally. Weight loss following birth is presumably mostly water loss that could result in hypohydration and subsequent hypernatremic dehydration. However, excess fluid loss immediately following birth is a normal and necessary process. Furthermore, newborns exposed to excess fluid intake during labor may need to lose ≥7% of birth weight in the first 2 days following birth in order to achieve euhydration. Normal newborn fluid loss following birth confounds the use of weight loss as the sole measure of newborn hydration. We thus propose the healthy newborn hydration model that highlights the normalcy of newborn weight loss immediately following birth and the healthy newborn's compensatory mechanisms for preserving adequate hydration. We also recommend the use of serum sodium to measure intravascular osmolarity in addition to monitoring weight loss to obtain a more comprehensive newborn hydration assessment. Research is necessary in healthy newborns to identify relationships among fluids received in utero, newborn weight loss, and hydration, as evaluated with laboratory measures, in the first 2 days following birth. This information will guide clinicians in correctly identifying newborns with inadequate hydration who are in need of supplementary fluids versus newborns with adequate hydration for whom exclusive breast-feeding can be supported and encouraged.

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Hyponatraemia and Brain Oedema in Newborns Following Oral Water Intoxication during Prolonged Labour

Cited by 7 publications

References 8 publications

Feto-maternal osmotic balance at term. A prospective observational study

Feto-maternal osmotic balance at term. A prospective observational study

Severe pre-eclampsia as a rare cause of profound hyponatraemia

The Healthy Newborn Hydration Model

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