On Wed, 27 Jul 2005 20:02:00 -0400, Claire Bloodgood 
<[log in to unmask]> wrote:

>On Wed, 27 Jul 2005 17:27:35 -0500, Kathy Eng <[log in to unmask]> wrote:
>
>>Claire, what research do they give for this information? thanks, Kathy
>Eng, BSW, IBCLC
>>
>
>Hi Kathy,
>I will find out and let you know.
>-Claire

Hi Kathy,
I have the references now, had to wait for permission to quote from Denise 
Fisher...

<
You could say that the hyponatremia is only caused by vasodilution, BUT the 
combination of excessive IV fluids, plus that fluid being glucose infusion, 
plus oxytocin being administered all work together to result in 
hyponatremia. 

<Vasodilution from administration of excessive fluids (IV or oral)is an 
obvious reason to see low sodium serum levels.
This is then compounded by the intravenous infusion being glucose. The baby 
is born hyperglycemic and this contributes to hyponatremia because serum Na 
concentration falls with the movement of fluid into the extracellular 
fluid, which occurs because the plasma glucose level is above normal. 
And then add oxytocin to that mixture, which we know has antidiuretic 
activities due to its biochemical similarity to anti-diuretic hormone and 
its action on the renal distal tubular receptors, and hyponatremia has got 
to be the expected outcome.

<One study found that the intravenous administration to the mother of 5 per 
cent dextrose and oxytocin resulted in statistically significant lower 
sodium levels in babies of mothers who had intravenous fluid compared to 
those who had no IV therapy.
This could be a dilutional outcome, rather than the dextrose and oxytocin.
Dahlenburg GW, Burnell RH, Braybrook R. The relation between cord serum 
sodium levels in newborn infants and maternal intravenous therapy during 
labour. Br J Obstet Gynaecol. 1980 Jun;87(6):519-22. 

<So.. to keep looking ...

<Another study found that maternal IV loading with 1500 ml fluid prior to 
epidural anesthesia before elective cesarean section (study used three 
different solutions normal saline 0.9%, Hartmann's solution and dextrose 
5%) resulted in a significant rise in glucose level accompanied by a 
significant decrease in sodium level in mothers and newborns of the group 
hydrated with the dextrose solution.
No oxytocin in this group and the dilutional effect was the same for all 
mothers - glucose appears to be the culprit here.
E. Z. Zimmer, I. Goldsteina, E. Feldmana and A. Glik; Maternal and newborn 
levels of glucose, sodium and osmolality after preloading with three 
intravenous solutions during elective cesarean sections. European Journal 
of Obstetrics & Gynecology and Reproductive Biology 23(1-2):61-65,1986. 

<In 1995 prospective randomised study on one hundred primigravid women who 
required oxytocin to augment labour compared dextrose infusion with normal 
saline. After delivery patients whose oxytocin was infused in dextrose had 
significantly lower serum sodium levels in both mother and baby compared to 
those who had their oxytocin administered in normal saline.
This, again, demonstrates that the infusion being used is the culprit 
rather than the volume being infused.
Stratton JF. Hyponatraemia and non-electrolyte solutions in labouring 
primigravida. Eur J Obstet Gynecol Reprod Biol 1995; 59(2): 149-51 

<D'Souza noted a 5% rate of hyponatremia in mothers receiving oxytocin 
induction using glucose as the medium for dilution, and an 8% rate in their 
newborns, despite fluid restrictions.
D'Souza SW. Oxytocin induction of labour: hyponatraemia and neonatal 
jaundice. Eur J Obstet Gynecol Reprod Biol 1986; 22(5-6): 309-17 

<Singhi also reports that hyponatraemia (cord serum sodium less than 130 
mmol/l) was seen in 71 of 180 (39%) infants born to mothers who received an 
intravenous infusion of aqueous glucose solution during labour (study 
group).
Singhi SC. Maternal fluid overload during labour; transplacental 
hyponatraemia and risk of transient neonatal tachypnoea in term infants. 
Arch Dis Child 1984; 59(12): 1155-8 
>



-Claire Bloodgood, IBCLC

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