Perioperative anesthetic management for cesarean section of a parturient with gestational diabetes insipidus

Lacassie, Héctor J.; Muir, Holly A.; Millar, Simon; Habib, Ashraf S.

doi:10.1007/bf03016563

Cited by 9 publications

(9 citation statements)

References 9 publications

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“…It is postulated that hypernatremia leads to increased local anesthetic potency due to the increased intra-extra neural sodium gradient and careful titration and administration of the local anesthetics is essential. If time permitted, fluid resuscitation with an arterial line and central venous pressure monitoring based on her calculated water deficit as well as desmopressin supplementation would have been desirable to at least partially correct the patient's fluid deficit and serum sodium, allowing careful titration of epidural anesthesia for Cesarean section [5].…”

Section: Discussionmentioning

confidence: 99%

Management of a Parturient with Preeclampsia and HELLP Syndrome Complicated by Gestational Diabetes Insipidus

Tyagaraj¹,

Mazur²,

Miller³

et al. 2016

OJAnes

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HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets) is considered to be a variant or severe form of pre-eclampsia, a life threatening complication of pregnancy. Gestational Diabetes Insipidus (GDI) can coexist with severe preeclampsia and HELLP syndrome. The combination of these two conditions presents a unique challenge to the anesthesiologist and the obstetric team, caring for this parturient. We present the case of a parturient with an unusual presentation of GDI, coexisting with severe preeclampsia and HELLP syndrome. She had two days history of polyuria and polydipsia as well as lethargy and rapidly rising serum sodium in addition to acute renal failure without any neurologic symptoms. Expeditious delivery of the baby and supportive management is essential for optimal outcomes. She underwent a repeat Cesarean section under combined spinal epidural (CSE) anesthesia. This patient was discharged on postoperative day five after clinical resolution of her signs and symptoms.

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Section: Discussionmentioning

confidence: 99%

Management of a Parturient with Preeclampsia and HELLP Syndrome Complicated by Gestational Diabetes Insipidus

Tyagaraj¹,

Mazur²,

Miller³

et al. 2016

OJAnes

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“…Previously, hypernatremia has been reported in a neonate born to a mother with GDI and HELLP syndrome . In another case of GDI, the hypernatremic neonate required mechanical ventilation due to persistent hypotonia and poor respiratory effort . Therefore, neonates who are born to mothers with symptoms suggestive of GDI should be promptly evaluated for electrolyte disturbances and closely monitored.…”

Section: Discussionmentioning

confidence: 99%

Acute presentation of gestational diabetes insipidus with pre‐eclampsia complicated by cerebral vasoconstriction: A case report and review of the published work

Mor

Fuchs

Zafra

et al. 2015

J of Obstet and Gynaecol

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Gestational diabetes insipidus (GDI) is a rare, self-limited complication of pregnancy. As it is related to excess placental vasopressinase enzyme activity, which is metabolized in the liver, GDI is more common in pregnancies complicated by conditions associated with liver dysfunction. We present a case of a 41-year-old woman at 38 weeks' gestation who presented with pre-eclampsia with severe features, including impaired liver function and renal insufficiency. Following cesarean section she was diagnosed with GDI, which was further complicated by cerebral vasoconstriction as demonstrated by magnetic resonance angiography. This case raises the possibility that cerebral vasoconstriction may be related to the cause of GDI. A high index of suspicion of GDI should be maintained in patients who present with typical signs and symptoms, especially in the setting of pregnancy complications associated with liver dysfunction.

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“…The recommended IV dose of DDAVP is 1–4 μg daily . Care must be taken to clinically and biochemically monitor the patient for signs of hypernatraemia (weakness, altered mental status, seizures, coma, etc.)…”

Section: Intrapartum and Postpartum Managementmentioning

confidence: 99%

“…This can result in damage to the central nervous system secondary to brain cell swelling. It is therefore recommended that serum sodium levels should be corrected no quicker than 1 mmol/l/hour …”

Section: Intrapartum and Postpartum Managementmentioning

confidence: 99%

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Diabetes insipidus in pregnancy

Quigley

Shelton

Issa

et al. 2018

The Obstetric & Gynaecologis

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There are various types of diabetes insipidus that occur due to different pathology that occurs outside of, during, and as a result of pregnancy. All pregnant women presenting with polyuria and polydipsia should be investigated with blood tests including urea and electrolytes, calcium levels and thyroid function tests. Plasma and urine osmolality can also be helpful in making the diagnosis. Additional symptoms that are suggestive of diabetes insipidus secondary to other underlying pathology (e.g. a pituitary tumour) are likely to require radiological imaging. Women diagnosed with diabetes insipidus should have regular consultant review in clinic with monitoring of serum electrolytes. They should also receive an antenatal anaesthetic review. A multidisciplinary approach should be adopted during labour and they should be managed on delivery suite with senior obstetric and anaesthetic input. Pre-eclamptic toxaemia (PET) and haemolysis, elevated liver enzymes and low platelets (HELLP) can exacerbate diabetes insipidus as hepatic dysfunction leads to a reduction in vasopressinase metabolism. Furthermore, it has been suggested that pituitary hypoperfusion due to this syndrome could also be a cause of gestational diabetes insipidus. These women present a therapeutic challenge as they are in a volume-depleted state as a consequence of DI, however they require judicious fluid management because of their PET. Early detection and effective management will reduce morbidity and mortality in both the mother and fetus. Untreated or undiagnosed, it has the potential to have serious consequences for the expectant mother and fetus. Learning objectivesTo understand the different subtypes of diabetes insipidus, their pathophysiologies and their effects during the ante-, peri-and postnatal periods. To appreciate that diabetes insipidus can herald the onset of underlying hepatic dysfunction with associated serious maternal and fetal consequences arising from both the biochemical abnormalities associated with diabetes insipidus and the secondary problems of impaired liver function. To appraise the current theories of the link between PET and diabetes insipidus.

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Perioperative anesthetic management for cesarean section of a parturient with gestational diabetes insipidus

Cited by 9 publications

References 9 publications

Management of a Parturient with Preeclampsia and HELLP Syndrome Complicated by Gestational Diabetes Insipidus

Management of a Parturient with Preeclampsia and HELLP Syndrome Complicated by Gestational Diabetes Insipidus

Acute presentation of gestational diabetes insipidus with pre‐eclampsia complicated by cerebral vasoconstriction: A case report and review of the published work

Diabetes insipidus in pregnancy

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