Beer potomania syndrome: Difference between revisions

Latest revision as of 22:10, 18 October 2023

Background

Constellation of electrolyte abnormalities that occur secondary to overconsumption of electrolyte-poor liquid with little other sources of nutrition (e.g. drinking a lot of beer and not eating much)
Poor overall electrolyte intake limits formation of normal renal urea gradient-->inability to excrete sufficient free water
Total body sodium may be depleted, yet still may have elevated urinary sodium/FENa due to dysfunction of water metabolism
Attention to proper nutrition during acute illness may obviate need for hypertonic saline

Clinical Features

History of chronic alcohol ingestion (in a hypotonic form like beer)
Protein malnutrition
Seizures
Altered Mental Status
Weakness

Differential Diagnosis

Ethanol related disease processes

Ethanol toxicity
Alcohol use disorder
Alcohol withdrawal
- Alcohol withdrawal seizures
- Delerium tremens
Electrolyte/acid-base disorder

Evaluation

Work-Up

Chem 10
Osmolality
ADH

Evaluation

Signs, symptoms and laboratory values consistent with water intoxication
- Hyponatremia
- Hypochloremia
- Hypokalemia
No evidence of another cause of hyponatremia (such as steroid] use, diuretic use, hyperlipidaemia, etc.)

Management

If seizing or other severe symptoms, bolus hypertonic saline
Otherwise, gentle replacement of electrolytes with close attention paid to diet is important

Disposition

Admit patient with:

References

Va Med. 1989 Jun;116(6):270-1. Beer potomania syndrome in an alcoholic. Harrow AS.

Authors:

@@ Line 1: / Line 1: @@
 ==Background==
-A constellation of electrolyte abnormalities that occur secondary to the over consumption of liquid that is electrolyte poor coupled with little other sources of nutrition.  The poor overall electrolyte intake limits the formation of a normal renal urea gradient which cause an inability to excrete sufficient free water. Patients may actually be total-body sodium depleted, yet have elevated urinary sodium and fractional sodium excretion due to this disorder of water metabolism. Attention to proper nutrition during the acute illness may obviate the need for potentially hazardous administration of hypertonic saline
+*Constellation of [[electrolyte abnormalities]] that occur secondary to overconsumption of electrolyte-poor liquid with little other sources of nutrition (e.g. drinking a lot of beer and not eating much)
+*Poor overall electrolyte intake limits formation of normal renal urea gradient-->inability to excrete sufficient free water
+*Total body sodium may be depleted, yet still may have elevated urinary sodium/[[FENa]] due to dysfunction of water metabolism
+*Attention to proper nutrition during acute illness may obviate need for hypertonic saline
-==Diagnosis==
+==Clinical Features==
-#a history of chronic alcohol ingestion (in a hypotonic form)
+*History of chronic alcohol ingestion (in a hypotonic form like beer)
-#protein malnutrition
+*Protein malnutrition
-#signs, symptoms and laboratory values consistent with water intoxication, including hyponatraemia, hypochloraemia and, usually, hypokalaemia
+*[[Seizures]]
-#no evidence of another cause of hyponatraemia such as steroid use, diuretic use, hyperlipidaemia, etc.
+*[[Altered Mental Status]]
+*[[Weakness]]
-==Work-Up==
+==Differential Diagnosis==
-Chem 10
+{{Ethanol DDX}}
-Osmolality
-ADH
-==DDx==
+==Evaluation==
-[[Hyponatremia]]
+===Work-Up===
-[[Seizures]]
+*Chem 10
-[[Altered Mental Status]]
+*Osmolality
-[[Weakness]]
+*ADH
-==Treatment==
+===Evaluation===
-If seizing or other severe symptoms, use hypertonic saline
+*Signs, symptoms and laboratory values consistent with water intoxication
-Otherwise gentle replacement of electrolytes with close attention paid to diet is important
+**[[Hyponatremia]]
+**Hypochloremia
+**[[Hypokalemia]]
+*No evidence of another cause of hyponatremia (such as [[steroid]]] use, [[diuretic]] use, hyperlipidaemia, etc.)
+==Management==
+*If seizing or other severe symptoms, bolus [[hypertonic saline]]
+*Otherwise, gentle replacement of electrolytes with close attention paid to diet is important
 ==Disposition==
-Admit patient with seizures, AMS, Severe hyponatremia
+Admit patient with:
+*[[Seizures]]
+*[[altered mental status]]
+*Severe [[hyponatremia]]
 ==See Also==
-*[[Alcohol Intoxication]]
+*[[Ethanol toxicity]]
-*[[Alcohol Withdrawal]]
-*[[Wernicke-Korsakoff Syndrome]]
-==Source==
+==References==
-Va Med. 1989 Jun;116(6):270-1.  Beer potomania syndrome in an alcoholic.  Harrow AS.
+<references/>
+*Va Med. 1989 Jun;116(6):270-1.  Beer potomania syndrome in an alcoholic.  Harrow AS.
 [[Category:FEN]]
-[[Category:Tox]]
+[[Category:Toxicology]]