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AM lipid panel was obtained (Table ). A CT of the abdomen and pelvis showed a distended gallbladder with dilatation of the intrahepatic and common biliary ducts with the CBD measuring up to 11 mm near the head of the pancreas. The serum sodium did not improve after IV fluids which were stopped as he looked clinically euvolemic. AM lipid was obtained (Figure). ERCP revealed a 2cm biliary/pancreatic stricture compatible with pancreatic cancer and a 7 F stent was placed. CA 19-9 was 149.6. His serum sodium improved spontaneously without intervention. At discharge, his corrected serum sodium improved to 132. A EUS guided biopsy confirmed a pancreatic adenocarcinoma. Discussion: Unmeasured proteins and/or lipids seen in intra-and extra hepatic cholestasis can falsely result in a low serum sodium. These spurious anomalies may impede diagnosis and initial management. A high degree of caution should be exercised when met with conflicting clinical and laboratory abnormalities. Clinicians may exercise inappropriate choice of fluids especially when met with those suffering from pancreatitis. This may further lead to complications of rapid correction of sodium and hypernatremia. A high clinical suspicion should be exercised when met with severe asymptomatic hyponatremia. Sodium should be monitored after relieving the obstruction. Measurement of serum lipids and evaluating for paraproteinemia can be helpful.[1915] Figure 1. Lipid profile.

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