Beer Potomania: Why Initial Fluid Resuscitation May Be Harmful

Abstract

Beer potomania is one of the less common causes of hyponatremia that we encounter. Patients usually have a recent history of binge drinking along with poor diet. The low solute content in alcoholic beverages limits daily urine output, and ingestion of extra fluid will cause dilutional hyponatremia as a result. Blindly providing intravenous fluid without an underlying cause of the hyponatremia can be detrimental, such as in patients with beer potomania. In our case, a patient presented to the emergency department due to poor oral intake from jaw pain and was found to be hyponatremic from alcohol intake. He initially received 2 liters of fluid, which caused overcorrection of his sodium, requiring more free water to lower his sodium as a result.

Figure 1

The Patient's sodium level throughout his hospital stay. He presented initially with a sodium level of 113 mmol/L at hour 0, then corrected to 127 mmol/L after receiving 2 liters of normal saline, which prompted a nephrology consult. The patient then received D5W and DDAVP, and sodium was able to lower to 119 mmol/L at hour 20.