Hyponatremia in pregnancy has unique multifaceted pathogenesis ⭐✨ ✨⚡
Here is a short 🧵 exploring this intriguing concept
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1.) Reset Osmostat
- Common in first 2 months of pregnancy
- Due to altered osmolality set point at which ADH is released
- Usually asymptomatic with 4-5 mEQ drop in Na levels.
- If you see hyponatremia beyond first 3 months of pregnancy, look for other causes.
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2.) Preeclampsia and SIADH
Proteinuria>> Intravascular volume depletion (akin to Cirrhosis, HF)>> nonosmotic stimulus to release ADH
Abnormal placenta>excess release of Oxytocin
Pregnant patients receive Oxytocin and IV fluids for multiple other reasons as well
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3. Placenta releases Vasopressinase (causes Diabetes insipidus like state normally)
Abnormal placenta in preeclampsia can't release Vasopressinase> high ADH
Preeclampsia mediated abnormal angiogenesis leading to placental dysfunction and iatrogenic aspects> low Na
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4. Hyponatremia in pregnancy has relevance for fetus as well.
Fetal Na levels equilibrate rapidly with mother's>> low fetal Na can cause seizures, jaundice, and tachypnea
Reflex suppression of ADH release in the fetus can lead to polyhydramnios
Thanks for reading
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