Hereditary nephrogenic diabetes insipidus: a major conundrum during labour and delivery

Hypernatremia will develop when a patient with nephrogenic diabetes insipidus cannot drink enough water to match her large obligatory urinary water loss. In preparation for monitoring labor and delivery in a woman with hereditary nephrogenic diabetes insipidus (NDI), our objective was to avoid dysnatremias and plan how to treat one should one occur. Specific concerns were raised regarding her ability to ingest and absorb enough water to match her usual urine flow rate of 10 ml/min, unreliable gastric emptying and intestinal motility, the possible need for rapid infusions of very hypotonic solutions and hyperglycemia, if large amounts of glucose-containing solutions would be infused.