protein in urine, hypertension, low potassium

[expert@preeclampsia.org]

35 years old, 15 pregnancies, 4 live births, Graves disease, diabetic. Now at 24 weeks in pregnancy. Have been put in hospital twice now due to very low potassium levels, sever headaches and high blood pressure. Blood sugars are great with 4 shots of insulin and 2000 calorie diet. A1C was 5.1 never higher. Every single urine test reviles blood and protein. Blood pressure runs high > 150/90. Doc has put me on potassium CL 10 MEQ ER. 2 tablets daily. PTU 100MG 3 times daily. TSH level at last check was 0.22. And a pain medication called Fioricet, for the headaches.

I truly believe I have pre-eclampcia. Slight edema in legs throughout day. But upon wakening in the mornings face and hands are swelled pretty bad with eyes almost swelled shut. First hospitalation at 20 weeks, blood pressure 198/96, sever headache, potassium so low, I could hardly walk, blood and protein in urine. They gave me a stadall shot, pain pill, and 100mg of labetalo blood pressure medication, and boluses of potassium. Kept me over night and sent me home. I feel awfully!!! What do you think??

[expert@preeclampsia.org]

One of the most difficult diagnoses to make in a pregnant chronic hypertensive is superimposed preeclampsia, especially in a diabetic patient. It is a challenge to even the most experienced maternal-fetal medicine subspecialist who usually manages such pregnancies as you describe.

You have multiple endocrine abnormalities involving diabetes and hyperthyroidism. Although your diabetes sounds well controlled, the hypertension does not. Lower potassium can be a sign of Conn Syndrome.

It is important to know the baseline urine protein release over 12 or 24 hours in order to compare it to what you are now releasing on a daily basis. You could have primary renal disease, it could be diabetic renal disease, or it could be superimposed preeclampsia.

You probably have been advised to consider genetic studies (advanced maternal age at 35 years, a risk factor for chromosomal abnormality which is itself a risk factor for very early preeclampsia development), you have several chronic disease conditions with 15 pregnancies which begs for sterilization to let your body recover and heal, and you could be developing significant disease complications which places this last pregnancy hopefully at high risk.

A maternal-fetal medicine subspecialist in your local area is highly recommended for you.