Severe pre-eclampsia as a rare cause of profound hyponatraemia

Abstract

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.

Case Report of Hyponatremic Seizures in a Term Neonate Attributed to Excessive Maternal Coconut Water Ingestion During Labor

“…In addition, preeclampsia, adrenal insufficiency, hypothyroidism, and Sheehan's syndrome can induce severe electrolyte abnormalities and hyponatremia. 12,13 In this case, the neonate's hyponatremia was attributed to maternal hyponatremia from large-volume coconut water ingestion. Coconut water has gained popularity and is marketed as a natural fluid for rehydration.…”

“…In addition, preeclampsia, adrenal insufficiency, hypothyroidism, and Sheehan’s syndrome can induce severe electrolyte abnormalities and hyponatremia. 12,13…”