Renal physiology and fluid and electrolyte disorders in pregnancy

Belzile, Maxime; Pouliot, Audrey; Cumyn, Annabelle; Côté, Anne Marie

doi:10.1016/j.bpobgyn.2018.11.008

Cited by 15 publications

(10 citation statements)

References 30 publications

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“…Serum sodium levels fall by 4-5 mmol/L in pregnancy, for a variety of reasons. 10 Systemic arterial vasodilatation causes activation of the renin-angiotensin system, leading to renal sodium reabsorption and water retention. Antidiuretic hormone (ADH) secretion occurs at a lower serum osmolality, and causes a net gain of free water.…”

Section: Peripartum Hyponatraemiamentioning

confidence: 99%

“…Although hyperosmotic or isosmotic hyponatraemia can occur due to uncontrolled hyperglycaemia or severe lipidaemia, the majority of cases are hypo-osmotic. 10 Severe pre-eclampsia is associated with hyponatraemia. 11 In some cases, the underlying pathology is thought to be mediated by syndrome of inappropriate ADH secretion (SIADH) and hypervolaemia.…”

Section: Peripartum Hyponatraemiamentioning

confidence: 99%

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Metabolic emergencies in pregnancy

Mohan

Banerjee

2021

Clinical Medicine

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In pregnancy, women are more likely to develop certain metabolic disturbances as a result of the physiological changes that occur. Diabetic ketoacidosis and hypoglycaemia occur at increased frequency in women with pre-existing and gestational diabetes, and starvation ketoacidosis can present towards the end of pregnancy and can cause severe illness. Peripartum hyponatraemia is increasingly recognised and can be associated with maternal and neonatal morbidity. This review describes these conditions in detail as well as treatment priorities and the impact on both mother and baby.

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Section: Peripartum Hyponatraemiamentioning

confidence: 99%

Section: Peripartum Hyponatraemiamentioning

confidence: 99%

Metabolic emergencies in pregnancy

Mohan

Banerjee

2021

Clinical Medicine

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“…diabetes, renal failure, or myocardial infraction are frequently observed in clinical practice (3)(4)(5). Hypokalemia, hyponatremia, hypochloremia, and hypocalcemia were common electrolyte abnormalities encountered in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…odds ratio (95% confidence interval) for poor functional outcome (mRS score[3][4][5][6] according to tertiles of serum electrolyte indicators 1.00 (0.86-1.16) 1.01 (0.86-1.19) 474 (12.51) 1.13 (0.97-1.32) 1.13 (0.96-1.1.40 (1.21-1.61) 1.30 (1.11-1.52) 534 (15.62) 1.35 (1.17-1.56) 1.27 (1.08-1.mRS, modified Rankin Scale.…”

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confidence: 99%

Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack

Wang

Tian

et al. 2021

Ann Transl Med

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Background: Abnormal electrolytes were closely related to the prognosis of various diseases, the prognostic role of electrolytes in stroke has not been investigated well. We aimed to investigate the association between electrolytes and clinical outcomes in patients with acute ischemic stroke (AIS) or transient ischemic attack (TIA).Methods: Data were recruited from the China National Stroke Registry III study. Patients were classified into three groups according to tertiles and the normal range of each electrolyte. Multivariable logistic and Cox proportional hazards regressions were adopted to explore the associations of electrolytes with poor functional outcomes [modified Rankin Scale (mRS) 3-6/2-6] and all-cause death at 3 months and 1 year.Results: A total of 10,299 eligible patients were enrolled. After adjusted for confounding factors, the first tertile electrolytes were associated with increased risk of poor functional outcome (mRS score 3-6) at 1 year, the adjusted odds ratios (95% confidence intervals) were 1.33 (1.14-1.55) for potassium, 1.41 (1.20-1.60) for sodium, 1.27 (1.08-1.48) for chloride, compared with the second tertile. Similar results were found when poor functional outcome was defined as mRS score 2-6 and all-cause death. However, almost no significant association was present of calcium with these outcomes. All results were consistent when each electrolyte was classified into three groups according to the normal range and the outcomes timepoint was set at 3 months.Conclusions: Lower levels of potassium, sodium, chloride but not calcium were associated with higher risk of poor functional outcomes and death in patients with AIS or TIA.

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“…There are many diagnostic challenges: first of all, in pregnancy, a low potassium level is not always seen as a specific warning by obstetricians, since it may derive from hyperemesis; secondly, the mild acidosis that is often observed in pregnancy increases the serum potassium level, thus masking a mild reduction; thirdly, at least in some settings, taking alimentary supplements rich in proteins, potassium, magnesium, etc., is quite popular in pregnancy, and this may correct a mild potassium deficit ( Table 2) [6].…”

mentioning

confidence: 99%

Preeclampsia: A Diagnosis-Nondiagnosis That Is Too Easily Made: The Case of Primary Hyperaldosteronism

Piccoli

Mannucci

2020

Kidney Blood Press Res

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After decades in which the major medical textbooks reported with slightly different wordings that preeclampsia (PE) in pregnancy is a transitory kidney disease ultimately cured when the mother delivers, we are finally acknowledging that PE is neither always transitory nor systematically cured and that it may be both the herald of future diseases of the kidney and the cardiovascular system and the epiphenomenon of an underlying disease, as the interesting and well-presented case series published here demonstrates [1][2][3]. While the number of systematic reviews, large-population studies, and long-term registry data are multiplying and most of them conclude with a generic statement that future studies, actions, and programs are needed, few if any changes are taking place in real-life clinical practice [4].The result of this dangerous combination of minimalism (PE is a self-healing disorder), lack of interdisciplinary collaboration (the pragmatic obstetrician holding that "nephrologists make things too complicated," while the cultivated nephrologist retorts that "obstetricians oversimplify"), short-sightedness, and common alibis (no time to see all these women after a PE episode, someone else should do it …) is that women who have already had a stressful and occasionally life-threatening episode of PE lose a precious occasion to receive a timely diagnosis of a potentially curable disease.The series reported here is a clear example of how pregnancy is a valuable but often missed occasion for diagnosis of a potentially serious disease: of the 14 patients described, only 3 were diagnosed as having primary hyperaldosteronism within 1 year from the discovery of hypertension, while in 8 the interval was 5 years or more (up to 12 years). Perhaps even more interestingly, hypertension was diagnosed (or first appeared) in preg-

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Renal physiology and fluid and electrolyte disorders in pregnancy

Cited by 15 publications

References 30 publications

Metabolic emergencies in pregnancy

Metabolic emergencies in pregnancy

Electrolytes and clinical outcomes in patients with acute ischemic stroke or transient ischemic attack

Preeclampsia: A Diagnosis-Nondiagnosis That Is Too Easily Made: The Case of Primary Hyperaldosteronism

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