Document Detail


Multiple lipoprotein and electrolyte laboratory artifacts caused by lipoprotein X in obstructive biliary cholestasis secondary to pancreatic cancer.
MedLine Citation:
PMID:  21784379     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
Lipoprotein X (Lp-X) is an abnormal lipoprotein which may form in patients with intra- and extra-hepatic cholestasis. The presence of very high levels of Lp-X has been shown to be a rare cause of pseudohyponatremia. We present a patient with severe obstructive cholestasis secondary to pancreatic cancer leading to very high Lp-X concentrations resulting in pseudohyponatremia, pseudohypokalemia, pseudohypochloremia and interference with the selective micellary solubilization direct low density lipoprotein cholesterol assay. These spurious laboratory anomalies impeded the initial clinical management of the patient including the attempted correction of the electrolyte abnormalities. After relief of obstruction following biliary stent placement, the patient's lipid levels normalized. Clinicians must be wary of laboratory artifacts and remember to correlate the laboratory values with the clinical presentation of the patient. Assays employing direct ion-selective electrodes such as those in blood gas analyzers are not subject to the interference of high concentrations of lipids or proteins, and maybe useful in situations where such interference is suspected. Furthermore the Vertical Auto Profile (VAP®) ultracentrifugation assay may be useful to detect lipoprotein X and low density lipoprotein cholesterol levels when the selective micellary solubilization technique fails to detect or quantify these lipid moieties.
Authors:
Tharsan Sivakumar; Sushela Chaidarun; Hong Kee Lee; Mark Cervinski; Richard Comi
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Publication Detail:
Type:  Journal Article     Date:  2011-05-18
Journal Detail:
Title:  Journal of clinical lipidology     Volume:  5     ISSN:  1933-2874     ISO Abbreviation:  J Clin Lipidol     Publication Date:    2011 Jul-Aug
Date Detail:
Created Date:  2011-07-25     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101300157     Medline TA:  J Clin Lipidol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  324-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2011 National Lipid Association. Published by Elsevier Inc. All rights reserved.
Affiliation:
Section of Endocrinology, Dartmouth Medical School/Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH 03756, USA.
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