Abstract
Purpose
Gestational diabetes insipidus (GDI) is a rare endocrinopathy complicating about 4:100,000 deliveries. We present the case of a preterm parturient with GDI and severe hypernatremia (serum sodium concentration = 174 mmol·L-1) presenting for an urgent Cesarean section.
Clinical features
Fluid resuscitation and desmopressin supplementation partially corrected the patient’s homeostasis, allowing us to carefully titrate epidural anesthesia for an urgent Cesarean section. After delivery, the patient was transferred to the intensive care unit. The serum sodium concentration of the mother and the neonate was normalized over 48 hr and three days respectively.
Conclusion
The careful perioperative management of GDI led to a favourable outcome of the mother and fetus.
Résumé
Objectif
Le diabète insipide gestionnel (DIG) est une endocrinopathie rare dans environ 4:100 000 accouchements. Nous présentons le cas ďune parturiente avant terme, atteinte de DIG et ďhypernatrémie sévère (sodium sérique à 174 mmol·L-1 ), admise pour une césarienne ďurgence.
Éléments cliniques
Une thérapie liquidienne et un ajout de desmopressine ont permis de corriger partiellement éhoméostasie et ďajuster soigneusement ľanesthésie péridurale pour la césarienne ďurgence. Après ľaccouchement, la patiente a été transférée à ľunité des soins intensifs. La concentration sérique de sodium de la mère et du nouveau-né a été normalisée, respectivement après 48 h et trois jours.
Conclusion
La prise en charge périopératoire minutieuse du DIG a été favorable à la mère et à ľenfant.
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References
Iwasaki Y, Oiso Y, Kondo K, et al. Aggravation of sub- clinical diabetes insipidus during pregnancy. N Engl J Med 1991; 324: 522–6.
Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med 2000; 342: 1493–9.
Robertson GL. Diabetes insipidus. Endocrinol Metab Clin North Am 1995; 24: 549–72.
Robertson GL. Antidiuretic hormone. Normal and disordered function. Endocrinol Metab Clin North Am 2001; 30: 671–94 vii.
Lindheimer MD, Davison JM. Osmoregulation, the secretion of arginine vasopressin and its metabolism during pregnancy. Eur J Endocrinol 1995; 132: 133–43.
Barbey F, Bonny O, Rothuizen L, Gomez F, Burnier M. A pregnant woman with de novo polyuria-polydipsia and elevated liver enzymes. Nephrol Dial Transplant 2003; 18: 2193–6.
Kennedy S, Hall PM, Seymour AE, Hague WM. Transient diabetes insipidus and acute fatty liver of pregnancy. Br J Obstet Gynaecol 1994; 101: 387–91.
Laszlo FA, Czako L. 1-deamino-/4-valine-8-D-argi- nine/-vasopressin (dVDAVP), a new synthetic vaso- pressin analog for treating diabetes insipidus. Int J Clin Pharmacol Ther Toxicol 1982; 20: 39–43.
British Medical Association and Royal Pharmaceutical Society of Great Britain. British-National-Formulary. Desmopressin, 48 ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2004.
Singer G, Brenner B. Fluid and electrolyte disturbances. In: Braunwald E, Harrison TR (Eds). Harrison’s Principles of Internal Medicine, 15th ed. New York: McGraw-Hill Medical Pub. Division; 2001: 271–82.
Fried LF, Palevsky PM. Hyponatremia and hypernatremia. Med Clin North Am 1997; 81: 585–609.
Rose B. Clinical Physiology and Acid Base and Electrolyte Disorders, 4th ed. McGraw-Hill; 1994: 720-3.
Bader AM. Neurologic and neuromuscular disease. In: Chestnut D (Ed.). Obstetric Anesthesia. Principles and Practice, 2nd ed. St. Louis, Mosby, Inc.; 1999: 963–85.
Tanifuji Y, Eger EI 2nd. Brain sodium, potassium, and osmolality: effects on anesthetic requirement. Anesth Analg 1978; 57: 404–10.
De Jong RH. Local Anesthetics, 1st ed. St. Louis, Mosby; 1994: 230–49.
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Lacassie, H.J., Muir, H.A., Millar, S. et al. Perioperative anesthetic management for cesarean section of a parturient with gestational diabetes insipidus. Can J Anesth 52, 733–736 (2005). https://doi.org/10.1007/BF03016563
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DOI: https://doi.org/10.1007/BF03016563