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Pseudohyponatremia is an often misdiagnosed condition that needs to be managed by addressing the underlying cause. Treatment of hyponatremic patients with intravenous fluids without ruling out pseudohyponatremia may aggravate a patient’s hyponatremia and result in adverse outcomes. In a patient whose sodium is deteriorating, it is critical to diagnose pseudohyponatremia early in the course and acquire necessary consultations, even if the patient is asymptomatic. We discuss a case of a man in his 20s with a history of liver transplantation who presented with unexplained dangerously low sodium while being asymptomatic. The case illustrates an uncommon cause of pseudohyponatremia due to lipoprotein-X hypercholesterolemia in a patient with cholestatic liver disease.

Hypercholesterolemia due to lipoprotein-X manifesting as pseudohyponatremia in a patient with cholestasis