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Unusual association of diseases/symptoms
Case report
Hyponatraemia compounding pre-eclamptic toxaemia in a patient with type 1 diabetes
  1. Emily Briggs1,
  2. Orene Greer1,2,
  3. Nishel Mohan Shah1,2 and
  4. Natasha Singh1
  1. 1Department of Obstetrics and Gynaecology, Chelsea and Westminster Hospital, London, UK
  2. 2Academic Department of Obstetrics & Gynaecology, Imperial College London, London, UK
  1. Correspondence to Dr Emily Briggs; emily.briggs7{at}nhs.net

Abstract

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.

  • obstetrics and gynaecology
  • endocrinology
  • diabetes

https://doi.org/10.1136/bcr-2020-236511

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    Footnotes

    • Contributors All authors listed contributed to the conception and design of the work, acquisition, analysis and interpretation of data. EB collected data and drafted the report which was revised critically by OG and NMS, overseen by NS. All authors have given approval of the final version to be submitted and accept responsibility for publication of the content of this report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.