Igbinedion Samuel O, Pandit Sudha, Mavuram Meher S, Boktor Moheb
Internal Medicine, LSU HSC Shreveport, Shreveport, Louisiana, USA.
Gastroenterology and Hepatology, LSU HSC Shreveport, Shreveport, Louisiana, USA.
BMJ Case Rep. 2017 Dec 1;2017:bcr-2017-221984. doi: 10.1136/bcr-2017-221984.
A 44-year-old man with uncontrolled diabetes and chronic pancreatitis presented with abdominal pain, jaundice and unintentional weight loss. Laboratory investigations were significant for hyponatraemia, an obstructive pattern of liver enzymes. Imaging was consistent with intrahepatic and extrahepatic biliary obstruction, and endoscopic evaluation revealed a long common bile duct stricture. Intravascular volume depletion, beer potomania and syndrome of inappropriate antidiuretic hormone (with concern for biliary or pancreatic malignancy) were considered in the work-up for the aetiology of the hyponatraemia. After 4 days of conventional treatment, hyponatraemia persisted. Lipid panel obtained revealed very high levels of total cholesterol. The patient underwent a successful biliary diversion and reconstruction surgery. Follow-up after 3 months showed a clinically stable patient with resolution of elevated liver enzymes, hyperlipidaemia and hyponatraemia. We illustrate this rare case of hyponatraemia secondary to hyperlipidaemia in obstructive biliary cholestasis. It is important for physicians to thoroughly investigate the aetiology of hyponatraemia at its onset.
一名44岁患有未控制的糖尿病和慢性胰腺炎的男性，出现腹痛、黄疸和非故意体重减轻。实验室检查显示低钠血症以及肝酶呈梗阻性模式具有显著意义。影像学检查结果与肝内和肝外胆管梗阻相符，内镜评估显示胆总管存在长段狭窄。在对低钠血症的病因进行检查时，考虑了血管内容量耗竭、啤酒性低钠血症和抗利尿激素分泌不当综合征（怀疑有胆管或胰腺恶性肿瘤）。经过4天的常规治疗后，低钠血症仍然存在。所获得的血脂分析显示总胆固醇水平极高。该患者接受了成功的胆管改道和重建手术。3个月后的随访显示患者临床情况稳定，肝酶升高、高脂血症和低钠血症均已缓解。我们展示了这例梗阻性胆汁淤积继发高脂血症导致低钠血症的罕见病例。医生在低钠血症发病时彻底调查其病因很重要。
