Abstract: SA-PO0600
Lipemic Lies: Diagnostic Deception in Hypertriglyceridemia-Induced Pancreatitis
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 2
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Capasso, Anthony, Westchester Medical Center Health Network, Valhalla, New York, United States
- Zodo, Alexandra Ge, University of Illinois Chicago, Peoria, Illinois, United States
Introduction
Severe hypertriglyceridemia accounts for 1–10% of pancreatitis cases and is typically seen when triglycerides exceed 1,000 mg/dL. Triglyceride hydrolysis generates free fatty acids, leading to pancreatic injury. Marked elevations produce lipemic serum, interfering with spectrophotometric assays and causing spurious values such as pseudohyponatremia and pseudohypobicarbonatemia. These artifacts mimic true metabolic derangements, creating diagnostic uncertainty. Recognition of both the etiology and associated laboratory interference is essential for accurate diagnosis and management.
Case Description
A 33-year-old male with no significant medical history presented with 12 hours of nonbloody, nonbilious vomiting and epigastric abdominal pain. His lipase was minimally elevated, but CT abdomen showed peripancreatic fat stranding and edema. He reports drinking 2 beers per week. Ultrasound showed hepatic steatosis, but no evidence of gallstones. Labs showed a sodium of 132 with calculated osmolality of 274, bicarbonate 10, and anion gap of 27. The hemoglobin was unable to be read by the lab. A venous blood gas revealed a normal pH of 7.34.
The patient was started on intravenous fluids and pain medications. Given the discordant serum bicarbonate and blood pH along with a nearly isoosmolar hyponatremia, laboratory interference was suspected. Subsequently, triglyceride level returned at 2,417 mg/dL and the patient was transferred to the intensive care unit for insulin infusion. The patient clinically improved and his triglycerides normalized. He was discharged on fenofibrate and a statin with endocrinology follow-up.
Discussion
This case highlights severe hypertriglyceridemia as an underrecognized cause of laboratory artifact. The uniqueness lies in the lipemic interference produced pseudohypobicarbonatemia that mimicked a severe metabolic acidosis despite a discordant clinical picture. Marked lipemia also prevented accurate hemoglobin measurement, emphasizing the importance of communicating with the laboratory when results are unreadable or inconsistent. Recognition of these artifacts and confirmation with blood gas analysis are essential to avoid misdiagnosis and unnecessary interventions.