355. Maternal and neonatal seizures secondary to severe hyponatraemia from acute intrapartum water intoxication

Abstract

Introduction We wish to highlight how unregulated intrapartum water ingestion can result in significant maternal and neonatal morbidity. Early symptoms can be non-specific or confused with common pregnancy complications such as pre-eclampsia. We present a case of maternal and neonatal seizures secondary to severe hyponatremia following water intoxication. We will discuss the challenges in identifying high risk patients and their subsequent management. Case presentation A healthy primiparous women presented at term in spontaneous labour. She developed a generalized seizure followed a short period of acute confusion and disorientation intrapartum. She was mildly hypertensive without proteinuria. Magnesium sulphate was given and an emergency caesarean section performed. Following delivery the neonate developed seizures. Cord blood gases were normal. Maternal and fetal bloods showed severe hyponatraemia. Their biochemical and hormonal profile was otherwise normal. Brain and renal imaging were normal. Both required intensive care treatment. Fluid excess was calculated and they were fluid restricted accordingly. Supplementary hypertonic saline was given. Both made a full neurological recovery. Collateral history revealed that the mother drank up to 4 litres of water following advice to remain well hydrated following severe hyperemesis during the first and second trimester. Discussion Identifying antenatal risk factors for hyponatraemia, strict fluid balance monitoring and renal function testing in labour may identify at risk women and reduce the incidence of seizures and associated morbidity secondary to water intoxication.