Severe hyponatremia in preeclampsia: a case report and review of the literature
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Severe hyponatremia in preeclampsia: a case report and review of the literature Yingying Pu1 · Xia Wang2 · Hualei Bu2 · Wenzhe Zhang2 · Ruihui Lu2 · Shuquan Zhang2 Received: 6 March 2020 / Accepted: 25 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose To summarize the clinical characteristics and treatments of preeclampsia complicated with hyponatremia. Methods We reported a new case of preeclampsia complicated with severe hyponatremia; searched for relevant articles from the PubMed, Scopus and Cochrane databases; and reviewed all reported cases. Results Twenty-one reported cases were found. Our case is 22nd, and the serum sodium level in this case was the lowest reported. After treatment comprising fluid restriction, hypertonic saline and caesarean section, a relatively good outcome was achieved. In all reported cases, SIADH, preeclampsia or the combined effect of preeclampsia and induced nephrotic syndrome were the speculated pathogeny. Termination was performed due to adverse manifestations; six cases underwent transvaginal deliveries, and sixteen cases underwent caesarean section. Fifteen patients recovered from hyponatremia within 72 h after delivery. Conclusion The pathogenesis of hyponatremia occurring in patients with preeclampsia is still unclear. Termination of the pregnancy led to a stabilization of the sodium level, ICU monitoring was necessary, and fluid restriction and hypertonic saline intake were applied; however, there was no evidence of the effectiveness of the treatments. Keywords Hyponatremia · Preeclampsia · Severe · Pregnancy
Introduction Preeclampsia is a systemic disorder associated with newonset hypertension, which occurs most often after 20 weeks of gestation and usually occurs with symptoms such as proteinuria and oedema [1]. Pathophysiologically, preeclampsia is characterized by increased endothelial permeability, the release of vasoconstrictive agents and microvascular spasm. Signs such as headache, visual disturbances and epigastric pain may appear in patients with severe preeclampsia. However, hyponatremia is a rare complication of Yingying Pu and Xia Wang contributed equally. * Shuquan Zhang [email protected] 1
Department of Obstetrics and Gynecology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, 758 Hefei Road, Qingdao 266035, Shandong, China
Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, 107 Wenhua Xi Road, Jinan 250012, Shandong, China
2
preeclampsia with no current guidelines. To the best of our knowledge, only twenty-one cases have been reported previously (Table 1). We reported a new case of preeclampsia complicated with severe hyponatremia; the serum sodium level, in this case, was the lowest among the reported cases. Additionally, we reviewed the literature to summarize the clinical characteristics and treatments of this disease.
Case report A 42-year-old woman, gravida 2, para 1, was admitted at 30+5 weeks for worsening h
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