An interesting cholesterol story

When I was in residency training, a young lady (early 30s) was admitted to our hospital for a possible heart attack. Seemed unlikely, but there was enough evidence (changes in her labs and ECG) to admit her for further work-up. It turned out to be an unusual and interesting case, but the most memorable part of her stay (for me), was due to a medical error.

As it happened, she hadn't eaten for several hours before she came to the ER, so the astute on-call resident (no, it wasn't me) ordered a fasting lipid panel. What happened next was a result of "shared management" - the patient was officially under the care of the general medical team, but they were deferring to the consulting team of cardiologists. Apparently, one of the consultants ordered another fasting lipid panel for the next morning, not realizing that one had already been done that day.

So, as I rounded on the patient on the morning of her second day in the hospital, I noticed two lipid panels on the chart, drawn less than 24 hours apart. Stress or dehydration could temporarily increase their blood concentrations, so one might expect them to be, if not close, at least proportional.

One would be wrong.

The only two values that were roughly similar (within 5 or so points of one another on the two separate days) were the HDL and the triglycerides. The total cholesterol and the LDL were drastically changed. On the first day, the LDL was well over the trigger value indicating treatment, and on the second day it was normal. The same was true of the total cholesterol.

I wish I could tell you I tilted at the windmills of modern medicine and tried to make a difference based on this obvious anomaly. I didn't - surviving residency sometimes means knowing when to keep your head down and your mouth shut.
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