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Case Reports
. 2008 Feb;23(2):202-5.
doi: 10.1007/s11606-007-0446-3. Epub 2007 Nov 10.

Pseudohyponatremia in a patient with HIV and hepatitis C coinfection

Brian T Garibaldi  1 , Scott J Cameron, Michael Choi
Affiliations
Case Reports

Pseudohyponatremia in a patient with HIV and hepatitis C coinfection

Brian T Garibaldi et al. J Gen Intern Med. 2008 Feb.

Abstract

Pseudohyponatremia refers to low serum sodium in the presence of normal plasma tonicity. Whereas pseudohyponatremia secondary to hyperlipidemia is a commonly recognized occurrence, falsely low sodium levels secondary to elevated protein are less frequently observed. We present in this paper the case of a man coinfected with HIV and hepatitis C who had pseudohyponatremia from hypergammaglobulinemia. As hypergammaglobulinemia is a frequent occurrence in both HIV and HCV, we suggest that pseudohyponatremia is an important and likely underdiagnosed phenomenon in this patient population. Clinicians need to be aware of the electrolyte exclusion effect and become familiar with the techniques used by their local laboratory in the measurement of serum electrolytes. Pseudohyponatremia should also be included in the differential diagnosis of an elevated osmolal gap, as the falsely lowered sodium level will lead to a falsely low calculated serum osmolality.

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Figures

Figure 1
Figure 1
Serum protein electrophoresis shows an increased total protein, an asymmetric broad-based gamma region, and beta–gamma bridging.
See this image and copyright information in PMC

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