Pre-eclampsia affects 5 - 8% of pregnancies in the USA and 3 - 14% of pregnancies worldwide. Classically, the syndrome includes hypertension and proteinuria that may be associated with edema, headache and worsening epigastric pain. This is postulated from vasospasm and endothelial cell damage. Hyponatremia in pre-eclamptic pregnancies has been described in few cases, most of which were twin pregnancies, and four of them had nephrotic syndrome. The management of hyponatremia requires a multidisciplinary approach and significant attention, as this condition can predispose to convulsions along with pre-eclampsia, thus, endangering the life of the mother and the child. We describe a case of a patient who developed pre-eclampsia and hyponatremia in the absence of proteinuria, at 34 weeks of a twin pregnancy; there was progression to oliguria with complete remission following delivery by cesarean section.