Severe hypernatremia after cesarean delivery secondary to transient diabetes insipidus of pregnancy.
BACKGROUND
Transient diabetes insipidus is an uncommon complication of pregnancy, usually manifesting with polydipsia and polyuria. This condition is considered to result from excess placental vasopressinase activity and is managed with deamino D arginine vasopressin.


METHODS
While on restricted oral intake after cesarean delivery, the patient gradually became disoriented and agitated in conjunction with markedly increased urine output disproportional to her intravenous crystalloid fluid intake. Marked hypernatremia of 178 mEq/dL was noted. Urine osmolality was low at 248 mOsm/L. The clinical presentation and electrolyte abnormalities were considered consistent with transient diabetes insipidus of pregnancy. The patient responded well to nasal-spray-administered deamino D arginine vasopressin and increased intravenous fluid intake, with resolution of symptoms and gradual normalization of serum sodium levels.


CONCLUSIONS
Transient diabetes insipidus of pregnancy should be considered in the differential diagnosis of severe hypernatremia in obstetric patients with restricted oral intake after operative delivery.
Sherer
David M
DM
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, State University of New York, Downstate Medical Center, Brooklyn, New York 11203, USA. dmsherer@aol.com
Cutler
Jed
J
Santoso
Paulus
P
Angus
Sandra
S
Abulafia
Ovadia
O
D000328:Adult; D002585:Cesarean Section; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage; D003919:Diabetes Insipidus / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006955:Hypernatremia / Q000209:etiology* / Q000628:therapy; D011182:Postoperative Care / Q000009:adverse effects; D011183:Postoperative Complications; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis
D003894:Deamino Arginine Vasopressin