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Pre-eclampsia complicated by severe hyponatraemia
  1. Annalisa Montebello1,2,
  2. John Thake3,
  3. Sandro Vella1,2 and
  4. Josanne Vassallo1,2
  1. 1Department of Diabetes and Endocrinology, Mater Dei Hospital, Msida, Malta
  2. 2Department of Medicine, Mater Dei Hospital, Msida, Malta
  3. 3Department of Obstetrics and Gynaecology, Mater Dei Hospital, Msida, Malta
  1. Correspondence to Dr Annalisa Montebello; a.montebello{at}


A 41-year-old woman was diagnosed with pre-eclampsia at 35 weeks gestation. She was treated with antihypertensives but, unfortunately, her condition became complicated by severe hyponatraemia. Her sodium levels rapidly dropped to 125 mmol/L. The cause for the hyponatraemia was the syndrome of inappropriate antidiuretic hormone secretion. She was initially managed with fluid restriction, but an emergency caesarean section was necessary in view of fetal distress. Her sodium levels returned to normal within 48 hours of delivery.

Pre-eclampsia is rarely associated with hyponatraemia. A low maternal sodium level further increases the mother’s risk for seizures during this state. Additionally, the fetal sodium rapidly equilibrates to the mother’s and may result in fetal tachycardia, jaundice and polyhdraminios. All these factors may necessitate an emergency fetal delivery.

  • endocrine system
  • obstetrics
  • gynaecology and fertility
  • metabolic disorders

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  • Contributors AM wrote the case. JT, SV and JV all reviewed the case thoroughly and added their expert advice both during the acute management of the patient and on the write up.

  • 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.