Beer potomania syndrome

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

Clinical Features

• a history of chronic alcohol ingestion (in a hypotonic form)
• protein malnutrition
• Seizures
• Altered Mental Status
• Weakness

Differential Diagnosis

Ethanol related disease processes

• Ethanol toxicity
• Alcohol withdrawal
  • Alcohol withdrawal seizures
  • Delerium tremens
• Electrolyte/acid-base disorder
  • Wernicke-Korsakoff syndrome
  • Beer potomania syndrome
  • Alcoholic ketoacidosis

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 hyponatraemia (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.

Authors

Ross Donaldson