BMJ Case Reports 2017; doi:10.1136/bcr-2017-221984
  • Reminder of important clinical lesson

Pseudohyponatraemia secondary to hyperlipidaemia in obstructive jaundice

  1. Moheb Boktor2
  1. 1Internal Medicine, LSU HSC Shreveport, Shreveport, Louisiana, USA
  2. 2Gastroenterology and Hepatology, LSU HSC Shreveport, Shreveport, Louisiana, USA
  1. Correspondence to Dr Samuel O Igbinedion, sigbi1{at}
  • Accepted 20 November 2017
  • Published 1 December 2017


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.


  • Contributors SOI and SP reviewed the literature and prepared the first draft of the case report. MSM provided information on the initial management and contributed to the study design. MB critically revised the manuscript. All authors have reviewed the final draft for submission.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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