An Interesting Case of Gestational Diabetes Insipidus

Abstract

A 23 years old primigravida, admitted in our Centre  at the 34^th week of pregnancy,  presented with fever   increased thirst and increased frequency of urine. She was primigravida, with normal past medical history. Blood  levels showed Urea – 53 mg/ dl Creatinine – 1.3 mg/dl   Na⁺ - 170 mmol/L K  -  3.8 mmol/L RBS – 106 mg/dl  Sr.calcium – 8.8 mg/dl specific gravity of the urine: 1006; no glucosuria or proteinuria was present. Urinary and plasma osmolality were 85 and 355 mOsm/l; water intake about 5500 mL/day; diuresis 6000 mL/day. She was diagnosed positive for enteric fever with elevated liver enzymes. On the basis   of the value of urine output and osmolality Gestational diabetes insipidus was diagnosed, after serum vasopressin level confirmed the same desmopressin 20 mg/day was started. Fetal monitoring and periodic ultrasound was done. Patient underwent an emergency LSCS in view of severe oligohydramnios and  delivered a female baby of  birth weight 1700 grams. This case illustrates some challenges in   the diagnosis and management of transient gestational DI.