A woman with primary biliary cirrhosis and hyponatremia

摘要: A 43-year-old woman with a medical history significant for hypertension, depression, and primary biliary cirrhosis (PBC)3 was admitted to the hospital after outpatient laboratory tests showed hyponatremia. Her complaints on admission included blurry vision, nausea, pruritus. review of systems otherwise negative. She declared no family hypercholesterolemia or premature heart disease. taking multiple medications including azathioprine, prednisone, amlodipine, losartan, prochlorperazine, sertraline, trazodone, fenofibrate, ranitidine, hydroxyzine, ursodiol, cholestyramine. Physical exam remarkable scleral icterus mild jaundice; xanthomas were noted. Laboratory studies performed (Table 1). Once more, patient found have hyponatremia, along hypokalemia hypochloremia. creatinine slightly above normal limits but stable compared past values. liver profile test panel increases in transaminases, increased alkaline phosphatase activity, hypoalbuminemia, hyperbilirubinemia, evidence cholestasis bile acids blood. View this table: Table 1. Patient results. The started intravenous fluids (0.9% sodium chloride). Subsequently, lipid ordered most recent total cholesterol (TC) value, measured 1.5 years prior, 322 mg/dL (8.3 mmol/L). Current testing revealed markedly plasma TC concentration 2156 (55.8 This highest value ever by our laboratory. Furthermore, sample appearance clear not grossly viscous lipemic. An investigation took place determine if an erroneous result. ### QUESTIONS TO CONSIDER 1. What are possible causes discrepant values? 2. steps can be taken result? 3. implications results her accurate? 4. mechanisms which lipemia interfere testing? ### LABORATORY INVESTIGATION We first searched interfering substances that could falsely increase …