Pseudo-hyponatremia is an uncommon laboratory finding that can lead to serious morbidity and mortality if not recognized abruptly. Often linked to conditions like hyperlipidemia or hyperproteinemia, pseudohyponatremia can mislead clinicians and result in misdiagnosis. We discuss this through two real-world case studies, explaining how it develops and how to diagnose it accurately. It's paramount that clinicians recognize and properly differentiate pseudohyponatremia from true hyponatremia to prevent wrong treatments. We stress the need to address the root causes in order to provide the optimal patient care.