[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-432868-105":59,"doc-detail-432868-en":130},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":123,"head_meta":125,"extra_data":127,"updated_unix":129},105,"en","when-the-numbers-lie-uncovering-pseudohyponatremia-after-an-anabolic-steroid-injection","When the Numbers Lie - Uncovering Pseudohyponatremia After an Anabolic Steroid Injection","","Pseudohyponatremia is a lab artifact where measured serum sodium appears falsely low despite normal serum osmolality. It commonly follows hypertriglyceridemia or paraproteinemia, but this case reports a rarer cause: inadvertent intravenous injection of an oil-diluted anabolic steroid. A 42-year-old healthy man developed nausea, vomiting, and presyncope after trenbolone injection. Serum sodium was 125 mmol/L with an osmolal gap, while point-of-care iSTAT showed true normonatremia, confirming pseudohyponatremia. Observation led to symptom improvement and normalization of values.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/when-the-numbers-lie-uncovering-pseudohyponatremia-after-an-anabolic-steroid-injection/432868/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/when-the-numbers-lie-uncovering-pseudohyponatremia-after-an-anabolic-steroid-injection/432868.png","ImageObject",300,407,{"name":92,"@type":93},"Danger Angel","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-29",true,{"@type":102,"interactionType":103,"userInteractionCount":24},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What is pseudohyponatremia and why does it happen?","Question",{"text":112,"@type":113},"Pseudohyponatremia is a lab artifact where serum sodium appears falsely low while serum osmolality remains normal. It typically occurs when elevated lipids or proteins displace plasma water or interfere with nonaqueous measurement methods.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did clinicians confirm the diagnosis in this case?",{"text":117,"@type":113},"The patient’s low sodium on main laboratory testing contrasted with normal measured serum osmolality and an osmolal gap. Point-of-care iSTAT showed a normal sodium level, indicating true normonatremia consistent with pseudohyponatremia.",{"name":119,"@type":110,"acceptedAnswer":120},"What underlying trigger was identified after the steroid injection?",{"text":121,"@type":113},"The case attributed pseudohyponatremia to inadvertent intravenous injection of an oil-diluted anabolic steroid, with nonaqueous solvent interference producing the falsely low sodium result.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},432868,1791230098,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":24,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52,"preview_page_count":4},962090769052,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","Review began 11/25/2025  \nReview ended 12/01/2025  \nPublished 12/05/2025  \n© Copyright 2025  \nLacasse et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CCBY 4.0. , which permits unrestricted use , distribution , and reproduction in any medium , provided the original author and source are credited.  \nDOI: 10.7759/cureus.98516  \nOpen Access Case Report  \nWhen the Numbers Lie: Uncovering Pseudohyponatremia After an Anabolic Steroid Injection  \nDanielle C. Lacasse 1 , Ashley M. Otto 1, Nathan Bosse 1, Matthew F. Baker 2  \n1. Internal Medicine, Naval Medical Center Portsmouth, Portsmouth, USA 2. Nephrology, Naval Medical Center Portsmouth, Portsmouth, USA  \nCorresponding author: Matthew F. Baker, [matthew.f.baker.mil@health.mil](matthew.f.baker.mil@health.mil)  \nAbstract  \nPseudohyponatremia is a laboratory artifact in which serum sodium levels appear falsely low despite normal serum osmolality. It typically occurs in the presence of hypertriglyceridemia or paraproteinemia, but this case highlights a rare etiology: inadvertent intravenous injection of an oil-diluted anabolic steroid. A 42-year-old healthy man presented to the emergency department with nausea, vomiting, and presyncope. He reported injecting trenbolone intramuscularly three days prior and noted blood aspiration before injection, suggesting possible intravenous administration. He denied other recent illnesses or exposures. On examination, he was afebrile, hemodynamically stable, and non-toxic, with an unremarkable physical exam. Initial laboratory results revealed a serum sodium level of 125 mmol/L. However, the measured serum osmolality was 289 mOsm/kg while the calculated osmolality was 259 mOsm/kg, revealing an osmolal gap. A point-of-care iSTAT revealed a sodium level of 137 mmol/L, indicating true normonatremia and supporting the diagnosis of pseudohyponatremia. Additional labs showed erythrocytosis, consistent with anabolic steroid use, and no evidence of hypertriglyceridemia or paraproteinemia. Nephrology was consulted due to concern for symptomatic hyponatremia. With a normal measured osmolality, normal lipid and protein levels, and a history of recent anabolic steroid injection, the low serum sodium level was attributed to a laboratory artifact resulting from nonaqueous solvent interference. The patient was admitted for observation and remained stable, with improving symptoms and normalizing labs. Serum sodium by mainlab indirect analysis was 136 mmol/L by the time of discharge on hospital day two. He was discharged withoutpatient follow-up. In patients with unexplained hyponatremia and normal clinical status, pseudohyponatremia must be considered. Prompt recognition can prevent unnecessary treatments, reduce patient risk, and guide appropriate care.  \nCategories: Internal Medicine, Nephrology, Healthcare Technology  \nKeywords: anabolic steroid, general nephrology, laboratory finding, pseudo-hyponatremia, serum osmolality  \nIntroduction  \nHyponatremia is a common laboratory abnormality in hospitalized patients [1] . Evaluating serum tonicity is critical, as the management of hyponatremia depends on whether the condition is hypotonic, isotonic, or hypertonic. Symptomatic hypotonic hyponatremia can be a medical emergency necessitating prompt recognition of the condition and the use of hypertonic saline to prevent brain herniation [2] .  \nBefore initiating treatment, it is essential to exclude causes of normotonic and hypertonic hyponatremia. Pseudohyponatremia is a laboratory artifact defined by a serum sodium concentration \u003C135 mEq/L in the setting of normal serum osmolality (275-295 mOsm/kg), typically resulting from displacement of plasma water by elevated concentrations of lipids or proteins [3,4] . Hypertonic hyponatremia, by contrast, occurs when serum sodium is low in the presence of elevated serum osmolality (>295 mOsm/kg), most often due to the presence of osmotically active solutes such as gl","cbCaieh7iwYkqQDb","https://ap.wps.com/l/cbCaieh7iwYkqQDb","pdf",104601,"English","# Introduction\n## Hyponatremia assessment by tonicity\n## Definition and mechanism of pseudohyponatremia\n## Differential causes of hyponatremia\n## Classical associations and reported etiologies\n## Context: anabolic-androgenic steroid misuse","[{\"question\":\"What is pseudohyponatremia and why does it happen?\",\"answer\":\"Pseudohyponatremia is a lab artifact where serum sodium appears falsely low while serum osmolality remains normal. It typically occurs when elevated lipids or proteins displace plasma water or interfere with nonaqueous measurement methods.\"},{\"question\":\"How did clinicians confirm the diagnosis in this case?\",\"answer\":\"The patient’s low sodium on main laboratory testing contrasted with normal measured serum osmolality and an osmolal gap. Point-of-care iSTAT showed a normal sodium level, indicating true normonatremia consistent with pseudohyponatremia.\"},{\"question\":\"What underlying trigger was identified after the steroid injection?\",\"answer\":\"The case attributed pseudohyponatremia to inadvertent intravenous injection of an oil-diluted anabolic steroid, with nonaqueous solvent interference producing the falsely low sodium result.\"}]","When the Numbers Lie - Uncovering Pseudohyponatremia After an Anabolic Steroid Injection | PDF",1790661686]