Beer potomania

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Editor-in-Chief: Suresh Samson, M.D., Yale Bridgeport Hospital

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Overview

Beer potomania simply means an excessive tendency to drink beer. One of the major complication of this act is Hyponatremia, which has been traditionally included in the name "beer potomania". This is a syndrome of binge drinking, poor nutritional intake, and profound hyponatremia.

Pathophysiology & Etiology

Hyponatremia is due to a large consumption of beer (which has a poor salt content) together with a minimal intake of ordinary food. There are three facts that we need to keep in mind before discussing the pathophysiology. First,beer has a lot of water with very little salt and protein(one litre of beer roughly has 30mg of sodium). Second, the urine flow(i.e the amount of free water we excrete) depends on number of osmoles that need to be excreted. Third, the kidneys can dilute the urine to a maximum of 50 mosm/L

Lets try to understand the mechanism of beer potomania with an example. Imagine someone who binged on 4L of beer(which means 4 L of water) with ingestion of roughly 200mosm that day( remember that a regular American diet has 750mosm/day, and all of it excreted in urine to maintain a steady state).With ingestion of this large amount of beer(i.e.water), his anti diuretic hormone(ADH) secretion is at its minimum to allow the kidneys to excrete maximally dilute urine. Since the maximal dilution that can be attained is 50mosm/L, the kidneys will excrete all the 200 mosm in the diet in 4 litres of urine (50mosm/L X 4L = 200 mosm). This will indeed maintain his sodium level.If this person in our example drinks his 5th litre of beer without taking any further osmoles, then he will become hyponatremic. This is beer potomania

References

http://alcalc.oxfordjournals.org/cgi/content/full/35/6/612

Differential Diagnosis

See the differential of hyponatremia

Electrolyte and Biomarker Studies

A value of Uosm < 100 mOsm/kg is indicative of a complete and appropriate suppression of antidiuretic hormone (ADH) secretion, a finding seen with either primary polydipsia (including ‘beer potomania’) or reset osmostat. Criteria used to diagnose the ‘beer potomania’ syndrome include

1. A history of binge beer drinking
2. Poor dietary intake
3. Decreased serum sodium levels
4. Low serum and urine osmolality
5. Absence of other known causes of hyponatremia

Acknowledgements

The content on this page was first contributed by: Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]

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