Water intoxication - A dangerous condition in labor and delivery rooms

Water intoxication, a form of acute hyponatremia, has been described in various clinical situations. Although hyponatremia is a common metabolic disorder in hospitalized patients, it is generally not well known as a hazard in the labor and delivery room. However, several factors predispose laboring women to develop hyponatremia. Moreover, because the fetus acquires water from the maternal circulation via the placenta, and there is a close correlation between maternal and cord blood serum sodium levels, the newborn infant of a hyponatremic mother is also at considerable risk of developing water intoxication. We review the epidemiology, pathophysiology, clinical features, and treatment of this hazardous disorder. We emphasize the need for awareness of this condition, and call attention to the risk of fluid overload during labor. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this article, the reader should be able to recall that clinical hyponatremia can occur during labor, which may be due to the treatments received during labor or to secondary causes, and to state that the fetus may also be adversely affected and the mother must be diagnosed and treated to prevent serious consequences.