Abstract: TH-PO0084
Pseudohypobicarbonatemia in Patients with Hypertriglyceridemia: A Retrospective Cohort Study
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Clinical Research
October 22, 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
- Velury, Pooja Kameswari, Saint Louis University School of Medicine, St. Louis, Missouri, United States
- Analitis, Evangelia, Saint Louis University School of Medicine, St. Louis, Missouri, United States
- Mishra, Vandana, Saint Louis University School of Medicine, St. Louis, Missouri, United States
- McMahan, Evan R., Saint Louis University School of Medicine, St. Louis, Missouri, United States
- Ryan, Irene, Saint Louis University School of Medicine, St. Louis, Missouri, United States
- Miyata, Kana, Saint Louis University School of Medicine, St. Louis, Missouri, United States
Background
We previously reported a case of pseudo-hypobicarbonatemia secondary to severe hypertriglyceridemia, characterized by a discrepancy between bicarbonate levels measured on the Basic Metabolic Panel (BMP) and blood gas analysis. The proposed mechanism involves lipid interference with photometric light absorbance during enzymatic reactions in automated analyzers used for BMP testing. To date, this phenomenon has been described only in case reports and small case studies, with no large cohort studies available. We performed a retrospective study to evaluate the association between elevated triglyceride (TG) levels and low bicarbonate measurements in BMP, and to determine how often this leads to unnecessary treatment for presumed metabolic acidosis.
Methods
We retrospectively reviewed electronic health records from inpatient and outpatient encounters within the SSM Health system. Adults aged ≥ 18 years with TG >1000 mg/dL were included. Patients with chronic kidney disease stage 5, ketoacidosis, lactic acidosis, dehydration, paraproteinemia, or amyloidosis were excluded. The study was approved by the Saint Louis University IRB.
Results
A total of 142 patients were included (mean age of 45.4 years; 74.6 % male, 85.9% Caucasian), with laboratory measurements performed at SSM Health, Quest Diagnostics, or LabCorp laboratories. BMP bicarbonate levels were negatively correlated with TG levels (r=-0.5138, p<0.0001). Moreover, the calculated anion gap (AG) was positively correlated with TG levels (r=0.4062, p<0.0001). Among eight patients with concurrent blood gas measurements, the mean bicarbonate level was 23.3 mEq/L on blood gas compared to 15 mEq/L on BMP. Among 44 cases with TG> 4000 mg/dL, six patients received sodium bicarbonate treatment despite the absence of confirmed metabolic acidosis.
Conclusion
Elevated TG levels are significantly associated with lower bicarbonate and higher anion gap values on BMP. Clinicians should recognize that severe hypertriglyceridemia can cause factitiously low bicarbonate levels on BMP, which may lead to inappropriate treatment.