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. The patient was treated with 500 mL of normal saline (300 Osm/L).
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.
In 1971 and 1972, beer drinker's hyponatremia (beer potomania) was described in 7 patients with long histories of consuming at least 4 L of beer per day, sodium-deficient diets, low serum sodium values (98107 mmol/L), unconsciousness, and seizures (4).
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. Retention of 5 L of free water will produce a serum sodium concentration of 125 mmol/L in a 70-kg man over a 24-h period and a serum sodium concentration of 113 mmol/L on the second day (7).
* 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.
* Beer potomania with biochemical findings of low serum sodium, low serum and urine osmolalities, and low urine sodium values can cause severe hyponatremia.
That helps narrow our differential diagnosis to glucocorticoid deficiency, hypothyroidism, and SIADH (Table 2, page 102).(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 SSRI use in elderly persons has been associated with hyponatremia, which in some cases may be consistent with SIADH.