B0080 - A Rare Case of Pseudohyponatremia in an Elderly Male With Pancreatic Adenocarcinoma: Laboratory Artifact or Idiopathic?

Mohammed Gandam, MBBS, MD, Aquila Fathima, MBBS, MD, Aashritha Ramesh, MD, Mahshid Mir, MD, Santhoshi Bavi, MBBS, MD, Alan Auerbach, MD, Sujatha Kailas, MD, MBA, George Atia, MD, Shyam Chalise, MD
Ascension Saint Joseph Hospital, Chicago, IL

Introduction: Electrolyte imbalance in patients with obstructive jaundice is rare. Case reports of pseudohyponatremia in patients with obstructive jaundice have been previously described by Sivakumar et. al and Adashek et. al. They described the artifactual hyponatremia in the setting of hyperlipidemia and hyper lipoproteinemia. We describe a case of pseudohyponatremia with obstructive jaundice with modest elevation in total cholesterol and LDL

Case Description/Methods: A 73-year-old Asian patient with a history of type 2 diabetes mellitus presented with a 4 week history of generalized malaise, 2 week history of yellowish discoloration of both eyes, nightly upper abdominal pain, nausea and 1 episode of vomiting. He reported 10 kg weight loss in the last 6 weeks. He was noted to have hyponatremia and elevated liver enzymes by his primary doctor and was sent to the ER. His serum sodium on admission was 117. Corrected sodium to hyperglycemia was 122. Measured serum osmolality was 261 and calculated was 275. He was treated with NS 1L over 10 hours and AM lipid panel was obtained (table 1). 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 (table 2). 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.




Disclosures:


Mohammed Gandam, MBBS, MD, Aquila Fathima, MBBS, MD, Aashritha Ramesh, MD, Mahshid Mir, MD, Santhoshi Bavi, MBBS, MD, Alan Auerbach, MD, Sujatha Kailas, MD, MBA, George Atia, MD, Shyam Chalise, MD. B0080 - A Rare Case of Pseudohyponatremia in an Elderly Male With Pancreatic Adenocarcinoma: Laboratory Artifact or Idiopathic?, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.