Gestational diabetes and central pontine myelinolysis with quadriplegia: a case report.
Central pontine myelinolysis (CPM) has been reported in women with severe hyperemesis gravidarum-induced hyponatremia followed by rapid correction. Gestational diabetes with adipsia complicated by acute hypernatremia resulting in CPM has never been reported. Here is a case of a disabled female who presented with polydipsia, polyuria, seizures, fetal death in utero, hyperglycemia, and hyper-osmolar hypernatremia on her 31st gestational week. The dead fetus was delivered and the patient's plasma glucose and sodium were later stabilized. When the patient developed quadriplegia and respiratory failure 5 days later, brain magnetic resonance imaging showed central pontine and extra-pontine myelinolysis. Gestational diabetes complicated by hyper-osmolar crisis may cause fetal death and severe neurologic sequela. Early recognition and delivery of the fetus and placenta may improve the electrolyte and fluid imbalance.
Lee
I-Wen
IW
Department of Obstetrics and Gynecology, National Cheng-Kung University Hospital, 138 Sheng-Li Road, Tainan, Taiwan.
Su
Mei-Tsz
MT
Kuo
Pao-Lin
PL
Chang
Chia-Ming
CM
D016640:Diabetes, Gestational / Q000175:diagnosis / Q000473:pathology; D006233:Persons with Disabilities; D005260:Female; D005313:Fetal Death / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D006955:Hypernatremia / Q000150:complications* / Q000175:diagnosis; D017590:Myelinolysis, Central Pontine / Q000175:diagnosis / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D011782:Quadriplegia / Q000175:diagnosis / Q000209:etiology*; D012640:Seizures / Q000150:complications / Q000175:diagnosis; D055815:Young Adult