Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
5985883 | Journal of Clinical Lipidology | 2015 | 5 Pages |
â¢Extremely high cholesterol levels may present as pseudohyponatremia.â¢Cholestasis may result in accumulation of lipoprotein-X.â¢Total cholesterol levels and routine sodium levels are inversely proportional.â¢Presence of lipoprotein-X is shown by lipoprotein electrophoresis.â¢Serum osmolality should be measured when pseudohyponatremia is suspected.
Pseudohyponatremia has been reported in association with severe hypertriglyceridemia and hyperparaproteinemia, but its association with severe hypercholesterolemia is not well-known. We report a 43-year-old woman with refractory primary biliary cirrhosis who presented with asymptomatic hyponatremia (121Â mmol/L; normal range: 135-145Â mmol/L). She was ultimately found to have a total serum cholesterol level of 2415Â mg/dL (normal range: 120-199Â mg/dL) - secondary to accumulation of lipoprotein-X-causing pseudohyponatremia. The diagnosis was confirmed by measurement of serum osmolality (296 mOsm/kg H2O; normal range: 270-300 mOsm/kg H2O) and serum sodium by direct potentiometry (141Â mmol/L). Furthermore, following 16 sessions of plasmapheresis over a 4-month period, there was marked lowering of serum cholesterol to 200Â mg/dL and normalization of serum sodium (139Â mmol/L) as measured by indirect potentiometry. This case shows that extreme hypercholesterolemia from elevation of lipoprotein-X particles in cholestasis can be a rare cause of pseudohyponatremia. It highlights the need to measure serum sodium with direct potentiometry in the setting of extreme hypercholesterolemia and consider this possibility before initiating treatment of hyponatremia.