A case of iatrogenic hypernatremia caused by multiple myeloma-associated pseudohyponatremia
10.3760/cma.j.cn114452-20240524-00269
- VernacularTitle:多发性骨髓瘤相关假性低钠血症致医源性高钠血症1例并回顾性分析
- Author:
Yuan HUANG
1
;
Lu ZHANG
;
Liangyu XIA
;
Jinyan LEI
;
Chong WEI
;
Yongzhe LI
Author Information
1. 北京协和医院检验科，北京 100730
- Keywords:
Multiple myeloma;
Pseudohyponatremia;
Indirect ion selective electrode method;
Direct ion selective electrode method;
Hyperglobulinemia
- From:
Chinese Journal of Laboratory Medicine
2024;47(10):1212-1214
- CountryChina
- Language:Chinese
-
Abstract:
The patient was a 55-year-old man. On February 16, 2024, he was admitted to Peking Union Medical College Hospital complaining of "weakness and poor appetite for more than half a year, and found creatinine increase for 1 week". The patient was diagnosed with multiple myeloma. During the treatment in our hospital, the patient sustained"hyponatremia"(Na 124-136 mmol/L measured by indirect ion selective electrode method), and combined with the patient′s clinical symptoms and serum osmotic pressure results (327 mOsm/kg H 2O), it was considered that hyperglobulinemia led to pseudohyponatremia. So no intervention was given. Subsequent failure to recognize pseudohyponatremia during treatment in other hospitals and the administration of hypertonic saline resulted in severe iatrogenic hypernatremia. By reviewing similar cases in our hospital, we found that hyperglobulinemia/hyperlipidemia associated pseudohyponatremia was not uncommon. This case reminds us that for patients whose serum solid phase ratio is higher than normal due to various reasons, the use of indirect ion selective electrode method to determine serum sodium is prone to false low, and direct ion selective electrode method can be used to re-test blood sodium to determine whether it is true, so as to avoid iatrogenic injury to patients.
