Severe Hypernatremia in an Eclamptic Patient with HELLP Syndrome: A Case Report

Background: Hypernatremia is a serum sodium concentration greater than 145mmol/L. When it exceeds 160mmol/L, it is classified as severe hypernatrenia. It is a rarely documented condition in obstetric practice which is associated with increased morbidity and mortality. Its occurrence in an eclamptic patient with HELLP syndrome further worsens the prognosis.  Case Presentation: A 22-year-old unbooked primigravida at 37 weeks of gestation who presented with multiple episodes of convulsion, loss of consciousness and jaundice. Her serum sodium was 181.3mmol/L on admission. She was managed as a case of antepartum eclampsia with HELLP syndrome and severe hypernatremia. Following resuscitation, she had an emergency caesarean section with a good perinatal outcome and was managed in the Intensive Care Unit (ICU) by a multidisciplinary clinical team. Her severe hypernatremia was treated exclusively with a gradual decrease in serum sodium and plasma osmolality, and also replacement of free water, which was done parenterally. Patient regained consciousness on day 14 of admission and was discharged home on day 31 for follow-up.  Conclusion: Severe hypernatremia is associated with high mortality if not properly managed. The same goes for eclampsia with HELLP syndrome. A patient presenting with these two medical conditions makes the prognosis worse; therefore, multi- disciplinary team management with adequate intensive care is required to achieve good perinatal and maternal outcomes as seen in our patient.