"Beer Potomania" - A Syndrome of Severe Hyponatremia with Unique Pathophysiology: Case Studies and Literature Review

Abstract

Beer potomania, a unique syndrome of hyponatremia, was first reported in 1972. It is described as the excessive intake of alcohol, particularly beer, together with poor dietary solute intake that leads to fatigue, dizziness, and muscular weakness. The low solute content of beer, and suppressive effect of alcohol on proteolysis result in reduced solute delivery to the kidney. The presence of inadequate solute in the kidney eventually causes dilutional hyponatremia secondary to reduced clearance of excess fluid from the body. Early detection of hyponatremia due to beer potomania in the hospital is necessary to carefully manage the patient in order to avoid neurological consequences as this syndrome has unique pathophysiology. We are reporting two cases, presenting to the emergency department with severe hyponatremia. After a detailed initial evaluation of the patients and labs for hyponatremia, a diagnosis of beer potomania was established in both cases. Considering the unique pathophysiology of beer potomania syndrome, the patients were closely monitored and treated appropriately to prevent any neurological sequelae.

Keywords: alcoholic beer; beer-potomania; dilutional hyponatremia; osmolar load; osmotic demyelination syndrome; potomania vs. siadh; serum sodium concentration; severe hyponatremia.

Figure 1. Serum sodium level (mmol/L) versus hospitalization time (hours).

Point A, shows serum sodium level of 118 mmol/L on admission, when patient was started on 0.9% sodium chloride, together with thiamine, magnesium sulfate and folic acid. Point B, shows serum sodium level of 129 mmol/L at 16 hours after admission, when nephrology was consulted. 0.9% sodium chloride was discontinued, a bolus of D5W was administered followed by D5W based banana bag. Point C, shows serum sodium level of 127 mmol/L at 24 hours since admission. Point D, shows serum sodium level of 131 mmol/L at 48 hours. Point E, shows serum sodium level of 133 mmol/L at 72 hours, and point F shows serum sodium level of 131 mmol/L at 96 hours.

Figure 2. Serum sodium level (mmol/L) versus hospitalization time (hours).

Point A, shows serum sodium level of 106 mmol/L on admission, when patient was started on 0.9% sodium chloride, together with thiamine, magnesium sulfate, folic acid and chlordiazepoxide. Point B, shows serum sodium level of 119 mmol/L at 16 hours after admission, 0.9% sodium chloride was discontinued. Point C, shows serum sodium level of 128 mmol/L at 36 hours since admission, nephrology was consulted at this point, 1 L bolus of D5W was given followed by D5W based banana bag. Point D, shows serum sodium level of 121 at 48 hours. Point E, shows serum sodium level of 126 mmol/L at 64 hours. Point F, shows serum sodium level of 129 mmol/L at 86 hours. Point G, shows serum sodium level of 131 mmol/L at 96 hours. Point H, shows serum sodium level of 133 mmol/L at 112 hours.