Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report
Abstract Background Torasemide, a loop diuretic, is rarely used for pregnant women because of the risk of reduced placental blood flow resulting from decreased circulating plasma volume. We experienced a case of a newborn with metabolic alkalosis and mild polyuria. The mother was suspected of self-m...
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BMC
2025-04-01
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| Series: | Journal of Pharmaceutical Health Care and Sciences |
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| Online Access: | https://doi.org/10.1186/s40780-025-00436-3 |
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| author | Yumi Kitahiro Mari Hashimoto Yukako Sonda Miki Yagi Kotaro Itohara Takumi Kido Kazumichi Fujioka Hitomi Imafuku Tomohiro Omura Ikuko Yano |
| author_facet | Yumi Kitahiro Mari Hashimoto Yukako Sonda Miki Yagi Kotaro Itohara Takumi Kido Kazumichi Fujioka Hitomi Imafuku Tomohiro Omura Ikuko Yano |
| author_sort | Yumi Kitahiro |
| collection | DOAJ |
| description | Abstract Background Torasemide, a loop diuretic, is rarely used for pregnant women because of the risk of reduced placental blood flow resulting from decreased circulating plasma volume. We experienced a case of a newborn with metabolic alkalosis and mild polyuria. The mother was suspected of self-medicating as we detected torasemide in the neonatal serum by LC-MS/MS method. Case presentation A Japanese pregnant woman in her 20s with mental illness, symptoms of panic and eating disorders, and a history of overdosing on over-the-counter medications, was referred to our hospital for birth control. She presented with vomiting following bulimia nervosa and hypokalemia. Her baby was delivered vaginally at 36 weeks and 4 days of gestation. The baby’s blood gas analysis on day 0 revealed metabolic alkalosis (pH > 7.42, HCO3 - > 28 mmHg). Up to 16 h after birth, mild polyuria and a urine output of 3.3 mL/kg/h were observed without the administration of diuretics. We suspected diuretic intake by the mother before delivery, because she had a history of taking torasemide before being referred to the hospital. As expected, torasemide was detected in the baby’s serum. The serum concentration on the first day after delivery (4.80 ng/mL) gradually decreased to 0.45 ng/mL on day 5, whereas torasemide was not detected in the maternal serum. Neonatal metabolic alkalosis improved by day 3 following birth. Conclusions This case suggests close counseling and monitoring of pregnant women before childbirth regarding their past and present use of drugs, particularly in those with mental illness. |
| format | Article |
| id | doaj-art-d4f37cb4e9234cebb5f04136b5c49087 |
| institution | OA Journals |
| issn | 2055-0294 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Pharmaceutical Health Care and Sciences |
| spelling | doaj-art-d4f37cb4e9234cebb5f04136b5c490872025-08-20T02:17:13ZengBMCJournal of Pharmaceutical Health Care and Sciences2055-02942025-04-011111510.1186/s40780-025-00436-3Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case reportYumi Kitahiro0Mari Hashimoto1Yukako Sonda2Miki Yagi3Kotaro Itohara4Takumi Kido5Kazumichi Fujioka6Hitomi Imafuku7Tomohiro Omura8Ikuko Yano9Department of Pharmacy, Kobe University HospitalDepartment of Pharmacy, Kobe University HospitalDepartment of Pharmacy, Kobe University HospitalDepartment of Pharmacy, Kobe University HospitalDepartment of Pharmacy, Kobe University HospitalDepartment of Pediatrics, Graduate School of Medicine, Kobe UniversityDepartment of Pediatrics, Graduate School of Medicine, Kobe UniversityDepartment of Obstetrics and Gynecology, Graduate School of Medicine, Kobe UniversityDepartment of Pharmacy, Kobe University HospitalDepartment of Pharmacy, Kobe University HospitalAbstract Background Torasemide, a loop diuretic, is rarely used for pregnant women because of the risk of reduced placental blood flow resulting from decreased circulating plasma volume. We experienced a case of a newborn with metabolic alkalosis and mild polyuria. The mother was suspected of self-medicating as we detected torasemide in the neonatal serum by LC-MS/MS method. Case presentation A Japanese pregnant woman in her 20s with mental illness, symptoms of panic and eating disorders, and a history of overdosing on over-the-counter medications, was referred to our hospital for birth control. She presented with vomiting following bulimia nervosa and hypokalemia. Her baby was delivered vaginally at 36 weeks and 4 days of gestation. The baby’s blood gas analysis on day 0 revealed metabolic alkalosis (pH > 7.42, HCO3 - > 28 mmHg). Up to 16 h after birth, mild polyuria and a urine output of 3.3 mL/kg/h were observed without the administration of diuretics. We suspected diuretic intake by the mother before delivery, because she had a history of taking torasemide before being referred to the hospital. As expected, torasemide was detected in the baby’s serum. The serum concentration on the first day after delivery (4.80 ng/mL) gradually decreased to 0.45 ng/mL on day 5, whereas torasemide was not detected in the maternal serum. Neonatal metabolic alkalosis improved by day 3 following birth. Conclusions This case suggests close counseling and monitoring of pregnant women before childbirth regarding their past and present use of drugs, particularly in those with mental illness.https://doi.org/10.1186/s40780-025-00436-3Metabolic alkalosisNewbornPregnancyTorasemideLoop diuretic |
| spellingShingle | Yumi Kitahiro Mari Hashimoto Yukako Sonda Miki Yagi Kotaro Itohara Takumi Kido Kazumichi Fujioka Hitomi Imafuku Tomohiro Omura Ikuko Yano Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report Journal of Pharmaceutical Health Care and Sciences Metabolic alkalosis Newborn Pregnancy Torasemide Loop diuretic |
| title | Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report |
| title_full | Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report |
| title_fullStr | Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report |
| title_full_unstemmed | Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report |
| title_short | Neonatal metabolic alkalosis and mild diuresis resulting from torasemide self-medication by the mother: a case report |
| title_sort | neonatal metabolic alkalosis and mild diuresis resulting from torasemide self medication by the mother a case report |
| topic | Metabolic alkalosis Newborn Pregnancy Torasemide Loop diuretic |
| url | https://doi.org/10.1186/s40780-025-00436-3 |
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