Pseudohyponatraemia secondary to hyperlipidaemia in obstructive jaundice

Abstract

A 44-year-old man with uncontrolled diabetes and chronic pancreatitis presented with abdominal pain, jaundice and unintentional weight loss. Laboratory investigations were significant for hyponatraemia, an obstructive pattern of liver enzymes. Imaging was consistent with intrahepatic and extrahepatic biliary obstruction, and endoscopic evaluation revealed a long common bile duct stricture. Intravascular volume depletion, beer potomania and syndrome of inappropriate antidiuretic hormone (with concern for biliary or pancreatic malignancy) were considered in the work-up for the aetiology of the hyponatraemia. After 4 days of conventional treatment, hyponatraemia persisted. Lipid panel obtained revealed very high levels of total cholesterol. The patient underwent a successful biliary diversion and reconstruction surgery. Follow-up after 3 months showed a clinically stable patient with resolution of elevated liver enzymes, hyperlipidaemia and hyponatraemia. We illustrate this rare case of hyponatraemia secondary to hyperlipidaemia in obstructive biliary cholestasis. It is important for physicians to thoroughly investigate the aetiology of hyponatraemia at its onset.

Significant High Lipid Profile in a Woman With Obstructive Jaundice

“…In all reported cases from the literature, the lipid elevations started after the development of obstructive jaundice. They resolved dramatically in the follow-up laboratory results after surgical intervention [ 5 , 8 , 9 ], indicating that the elevated lipid profile—mainly in LDL—is temporary and secondary to obstructive jaundice. Once this obstruction is managed, the lipid profile drops within weeks of intervention.…”

“…In 2008, researchers reported a high LDL level of 27.67 mmol/L (1070 mg/dL) in a 45-year-old woman after obstructive jaundice [ 9 ]. In 2017, researchers reported another case of LpX in a 44-year-old man with a significantly increased LDL level of 58.11 mmol/L (2247 mg/dL) with obstructive biliary cholestasis [ 5 ].…”

Pseudohyponatremia Secondary to Hypercholesterolemia in the Setting of Intrahepatic Cholestasis due to Metastatic Liver Disease: A Case Report and Review of the Literature

“…The reported underlying mechanisms included cholestasis secondary to graft-versus-host disease after bone marrow transplantation in four patients (6)(7)(8), primary biliary cirrhosis in three patients (9)(10)(11), medication-induced obstructive jaundice in three patients (12)(13)(14), hepatitis C infection (15), chronic pancreatitis (16), autoimmune pancreatitis and lymphoplasmacytic sclerosing cholangitis (17), and pancreatic cancer (18) in one patient each.…”

Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management

“…Table 3 lists clinical states in which pseudohyponatremia has been reported, including conditions associated with hyperproteinemia [41,[66][67][68][69][70][71][72][73][74][75][76][77][78][79][80], hypertriglyceridemia [19,68,[81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] and hypercholesterolemia [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112]…”

“…Table 3 lists clinical states in which pseudohyponatremia has been reported, including conditions associated with hyperproteinemia [ 41 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ], hypertriglyceridemia [ 19 , 68 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ] and hypercholesterolemia [ 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 ].…”