Urinary retention and syndrome of inappropriate antidiuretic hormone secretion (SIADH) secondary to impacted gravid uterus

Abstract

Urinary retention is an emergency that rarely occurs during pregnancy. Previous case reports have suggested multiple risk factors that can cause the gravid uterus to become impacted in the pelvis leading to lower bladder or urethral compression with subsequent urinary retention. However, no cases of urinary obstruction in a pregnancy that was complicated with severe electrolyte imbalance have been reported. To our knowledge, we report the first case of a 31-year-old woman presenting at 8 weeks' gestation with acute urinary retention caused by a retroflexed, retroverted uterus with a 6-cm posterior uterine fibroid leading to syndrome of inappropriate antidiuretic hormone secretion and severe hyponatremia requiring intensive care unit admission. The cornerstones of effective management of urinary retention should include: (i) urgent bladder catheterization; (ii) assessment of sodium levels to rule out syndrome of inappropriate antidiuretic hormone secretion, and prompt treatment before neurological damage occurs; (iii) reduction of the impacted uterus; and (iv) monitoring for post-obstructive diuresis.

Hyponatraemia caused by transient syndrome of inappropriate antidiuresis to urinary retention

“…In four patients, the sodium level corrected slowly within 2 to 10 days 2,6–8 . In five patients, a rapid autocorrection was described, where sodium normalised in 7 to 15 h 4,5,7,9 . No cases were described in which patients were administered desmopressin, as in our cases.…”

“…In four patients, the sodium level corrected slowly within 2 to 10 days. 2,[6][7][8] In five patients, a rapid autocorrection was described, where sodium normalised in 7 to 15 h. 4,5,7,9 No cases were described in which patients were administered desmopressin, as in our cases. To allow a controlled and gradual rise of serum sodium of maximum of 10 mmol/24 h. 10 We successfully combined desmopressin and fluid restriction in two of our patients, preventing osmotic demyelination (Table 2).…”

“…Although it is not a well‐known cause of hyponatraemia, the coexistence of hyponatraemia and urinary retention has been previously described. We performed a search of the literature and found one case series and seven case reports 2–9 describing a total of 14 cases. There was no difference in sex of the patients (seven men and seven women).…”

Postoperative urinary retention induced hyponatremic seizure following total knee arthroplasty with an enhanced recovery after surgery protocol: a case report and literature review

“…The literature review methods, including search strategy, selection criteria, study selection, and data extraction, were provided in Additional le 1. A total of 13 studies consisting of 21 patients were reviewed (Table 1) [4][5][6][7][8][9][10][11][12][13][14][15][16].…”