Authors :
Oluwaseye F. Oyeniran; Olubunmi Ogein; Odutola I. Odetunde; Olatubosun O. Olawanle; Sampson C. Aliozor; Adebowale T. Odun-Afolabi; Paulina K. Akowundu; Lere P. Oluwadare; Oyindamola O. Aderinto; Joshua Awofeso; Christian E. Amiwero; Eniola Adisa; Glory D. Chibuike
Volume/Issue :
Volume 10 - 2025, Issue 4 - April
Google Scholar :
https://tinyurl.com/5f53jbhe
Scribd :
https://tinyurl.com/yw2bmnc3
DOI :
https://doi.org/10.38124/ijisrt/25apr293
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Abstract :
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.
Keywords :
Eclampsia, HELLP syndrome, Hypernatremia, Severe.
References :
- Ambia AM, Wells CE, Yule CS, Mclntire DD, Cunningham FG. Fetal heart rate tracings associated with eclampsia seizures. Am J Obstet Gynecol. 2022 Oct. 227 (4):622.e1-622.e6.
- Vigil-De Gracia P. Maternal deaths due to eclampsia and HELLP syndrome. Int J Gynaecol Obstet. 2009 Feb. 104(2):90-94.
- Abalos E, Cuesta C, Carroli G, Qureshi Z, Widmer M, Vogel JP, et al. Pre-eclampsia, eclapsia and adverse maternal and perinatal outcomes: a secondary analysis of the World Health Organization Survey on Maternal and Newborn Health. BJOG. 2014;121 (Suppl 1):14-24.
- Priya R, Kavitha D, Glory MR, Kavitha M. Study of serum calcium and magnesium levels in pre-eclampsia and eclampsia compared to normotensive and its effects on maternal and perinatal outcome. Int J Acad MED Pharm 2023; 5(1):973-975.
- Uddin SMN, Haque M, Barek MA, Chowdhury MNU, Das A, Uddin MG. et al. Analysis of serum calcium, sodium, potassium, zinc and iron in patients with pre-eclampsia in Bangladesh: A case-control study. Health Sci Rep. 2023;6(2):e1097.
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- Alshayeb HM, Showkat A, Babar F, Mangold T, Will BM. Severe hypernatremia correction rate and mortality in hospitalized patients. Am J Med Sci. 2011; 341(5): 356-360.
- Sibai BM. Treatment of hypertension in pregnant women. N. Eng. J. Med. 1996; 335:257-260.
- Committee opinion no 652: Magnesium sulfate use in obstetrics. Obstet Gynecol. 2016 Jan. 127(1):e52-53.
- Sibai BM. The HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets): much ado about nothing. Am J Obstet Gyanecol. 1990; 162:311-316.
- OBrien JM, Barton JR. Controversies with the diagnosis and management of HELLP syndrome. Clin Obstet Gynecol. 2005 Jun. 48 (2): 460-477.
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.
Keywords :
Eclampsia, HELLP syndrome, Hypernatremia, Severe.