Beer potomania syndrome

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
  • Alcoholic ketoacidosis
  • Beer potomania syndrome
  • Beriberi
  • Thiamine deficiency
  • Wernicke-Korsakoff syndrome

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:

• Seizures
• altered mental status
• Severe hyponatremia

See Also

• Ethanol toxicity

References

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