Triglycerides and Sodium: Unmasking Pseudohyponatremia in a Clinical Case

Sodium is one of the most important minerals in human blood. Sodium disorders, either in the form of hypernatremia or hyponatremia, have detrimental effects on the body; therefore, they warrant urgent attention. Hyponatremia occurs in various clinical scenarios; it can be further categorized as true hyponatremia and pseudohyponatremia. When blood gets high protein or fat contents, it factitiously lowers the sodium level, which is termed pseudohyponatremia. The management scheme for both true hyponatremia and pseudohyponatremia is different; hence, careful clinical co-relation is needed while dealing with such scenarios. We present a case of a 59-year-old gentleman referred by a general practitioner for severe hyponatremia. The patient demonstrated hyperglycemia on admission, hence started on variable rate insulin, and further investigations had been done to screen for metabolic syndrome. Routine investigations showed severe hypertriglyceridemia, leading to a diagnosis of pseudohyponatremia. The patient had been discharged with the dual anti-lipid-lowering and anti-hyperglycemic regimen. This case denotes the importance of understanding and differentiating pseudohyponatremia from true hyponatremia, which is essential to avoid mismanagement of sodium levels in clinical practice.