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Perioperative anesthetic management for Cesarean section of a parturient with gestational diabetes insipidus

[Démarche anesthésique périopératoire pour la césarienne chez une parturiente atteinte de diabète insipide gestationnel]

Hector J. Lacassie, MD^*,, Holly A. Muir, MD FRCPC^*, Simon Millar, MBCHB FRCA and Ashraf S. Habib, MBBCH MSc FRCA^*

^* From the Division of Women’s Anesthesia, Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina, USA;
the Department of Anesthesiology, Pontificia Universidad Católica de Chile, Santiago, Chile; and
the Department of Anesthesia, Glasgow Royal Infirmary, Glasgow, United Kingdom.

Address corrrespondence to: Dr. Hector J. Lacassie, DUMC 3094, Bin 9, Durham, NC, 27710, USA. Phone: 919-681-6535; Fax: 919-668-6265; E-mail: lacas001{at}mc.duke.edu

Purpose: Gestational diabetes insipidus (GDI) is a rare endocrinopathy complicating about 4:100,000 deliveries. We present the case of a preterm parturient with GDI and severe hypernatremia (serum sodium concentration = 174 mmol·L^–1) presenting for an urgent Cesarean section.

Clinical features: Fluid resuscitation and desmopressin supplementation partially corrected the patient’s homeostasis, allowing us to carefully titrate epidural anesthesia for an urgent Cesarean section. After delivery, the patient was transferred to the intensive care unit. The serum sodium concentration of the mother and the neonate was normalized over 48 hr and three days respectively.

Conclusion: The careful perioperative management of GDI led to a favourable outcome of the mother and fetus.