Severe Hyponatremia and Ascites Associated with Preeclampsia

Hyponatremia and ascites are rare findings in preeclampsia (PE) and have been suggested to be a feature of severity and associated with adverse pregnancy outcomes. The presence of both with PE was reported once in the literature. To our knowledge, this is the second case of PE with hyponatremia and ascites and the first case of recurrent ascites with PE. A 29-year-old gravida 2, para 1, was admitted with early-onset PE at 26 weeks of gestation. Admission labs revealed severe hyponatremia. Ultrasound showed significant maternal ascites and a growth-restricted fetus with abnormal umbilical artery Doppler. Few days later, the patient developed oliguria and had a cesarean section. The maternal hyponatremia was corrected after delivery and the ascites had completely resolved in her post-partum visit. Neonatal hyponatremia was also noted. The exact pathophysiology of these findings is unknown. Nephrotic syndrome with hypoalbuminemia may be the contributing factor.