His severe hyponatremia and history of excessive consumption of beer, a poor source of sodium and protein, coupled with his poor intake of food was consistent with the diagnosis of beer potomania.
Given this patient's clinical history of excessive beer intake, poor food intake, laboratory findings of severe hyponatremia and low serum and urine osmolalities, and low urinary sodium concentrations, the diagnosis of beer potomania was made.
ADH concentrations are usually suppressed in patients with beer potomania, because they have an excess of water without the solute needed for diuresis (7, 8).
In 2007, a review of 22 published cases of beer potomania revealed a shared history of excessive beer intake, often long-term, with frequent recent episodes of binge drinking and poor dietary intake (8).
This volume is roughly equivalent to 14 cans of beer (12-oz cans), a level of beer consumption common among patients with beer potomania.
Severe hyponatremia is caused by an excess of water relative to sodium stores and may be caused by diuretics, vomiting, diarrhea, congestive heart failure, cirrhosis, inappropriate secretion of ADH, and, rarely, beer potomania and excess intake of water alone.
5) We exclude psychogenic polydipsia, "tea and toast" syndrome, or beer potomania because they usually present as euvolemic hyponatremia with low urinary osmolality.
Table 2 Hyponatremia: Differential diagnosis Hypovolemic Euvolemic hyponatremia Hypervolemic hyponatremia Vomiting Normal urinary Sodium Congestive heart failure Diarrhea Glucocorticoid deficiency Nephrotic syndrome Laxative Hypothyroidism abuse Cirrhosis Renal disease Certain drugs Nasogastric SIADH Suction Salt-wasting nephropathy Addison's Low urinary osmolality disease Psychogenic polydipsia Tea and toast' syndrome Beer potomania SIADH: syndrome of inappropriate antidiuretic hormone Source: Reference 5
This case describes a more unusual cause of hyponatremia, so-called
beer potomania (2), in which free-water (out of proportion to osmoles) ingestion is the culprit.
