IN THE NEWS --->Pre eclampsia as hyponatremia

We reported in the current Clinical Nephrology about pre eclampsia presenting as hyponatremia and resolving only after delivery. Classically the syndrome presents with hypertension and proteinuria; the presumed pathophysiologic mechanisms involve both maternal and placental factors resulting in endothelial damage and placental hypoperfusion. Multiple gestations are a known risk factor for development of preeclampsia.  Hyponatremia in preeclamtic pregnancy has been described in few cases, many of which were twin pregnancies.  We believe the physiology of non-singleton pregnancies causes a hepato-renal like syndrome and the development of hyponatremia occurs in the setting of increased free water intake.  Because of this physiology, patients are at risk for developing azotemia and preeclampsia.  Awareness of this potential entity in non-singleton pregnancies is key for prenatal care and frequent monitoring of serum Na should be routine.