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The authors present the case of a low-risk nulliparous woman presenting with frontal headache and normal BP at 31<jats:sup>+2<\/jats:sup> weeks gestation. Laboratory investigations confirmed a sodium of 123\u2009mmol\/L. Her urine protein creatinine ratio was 322\u2009mg\/mmol. She developed PET (BP 171\/100\u2009mm Hg) refractory to pharmacological management. She underwent an emergency lower segment caesarean section and was delivered of a live neonate. The maternal serum sodium normalised within 24 hours. Hyponatraemia should be regarded as a marker of severity in the setting of pre-eclampsia and may be an indication for an expedited delivery. Prompt management is required to prevent convulsions, maternal mortality and adverse fetal outcomes.<\/jats:p>","DOI":"10.1136\/bcr-2022-253881","type":"journal-article","created":{"date-parts":[[2023,9,1]],"date-time":"2023-09-01T11:20:42Z","timestamp":1693567242000},"page":"e253881","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Severe pre-eclampsia as a rare cause of profound hyponatraemia"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5499-415X","authenticated-orcid":false,"given":"Louise","family":"Dunphy","sequence":"first","affiliation":[{"name":"Department of Obstetrics, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yasmin","family":"Sadik","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zubair","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samira","family":"Furara","sequence":"additional","affiliation":[{"name":"Department of Obstetrics, Mid Cheshire Hospitals NHS Foundation Trust, Crewe, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,9,1]]},"reference":[{"key":"2025082700201914000_16.9.e253881.1","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1016\/j.preghy.2021.08.116","article-title":"Pregnancy outcomes in women with Hyponatraemia and pre-Eclampsia: case series and literature review","volume":"26","author":"Morton","year":"2021","journal-title":"Pregnancy Hypertens"},{"key":"2025082700201914000_16.9.e253881.2","unstructured":"Kinght M , Nair DT , Kenyon S , et al . 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