Pseudohyponatremia in acute hyperlipemic pancreatitis. A potential pitfall in therapy
J. M. Howard and J. Reed
Six patients had apparent hyponatremia associated with hyperlipidemia and
acute pancreatitis. To our knowledge, only one such patient with acute
pancreatitis has previously been described, although the association of
hyperlipidemia with "pseudohyponatremia" had been well documented. One of
the above patients, whose condition was hemodynamically unstable on
admission, developed dangerous symptoms of hyperosmolarity and cerebral
dysfunction following aggressive resuscitation with hypertonic saline
solution. The pseudohyponatremia results from displacement of water in the
serum by the lipids, with sodium existing only in the aqueous phase. This
volume displacement results in errors of sodium measurement when the latter
is determined by flame photometry or indirect potentiometry, but not when
determined by ultracentrifugation and direct potentiometry.