Potomania, also known as beer potomania and beer drinkers hyponatremia, is a
specific hypo-osmolality syndrome related to massive consumption of beer,
which is poor in solutes and electrolytes. With little food or other
sources of electrolytes, consumption of large amounts of beer or other dilute
alcoholic drinks leads to electrolyte disturbances. The symptoms of potomania
are similar to other causes of hyponatremia and include dizziness,
muscular weakness, neurological impairment and seizures, all related to
hyponatraemia and hypokalaemia. While the symptoms of potamania are similar to
other causes of hyponatremia and acute water intoxication, it should be
considered an independent clinical entity due to the often chronic nature
of onset, pathophysiology, and presentation of symptoms.
Pathophysiology The normal human kidney, through
suppression of anti-diuretic hormone, is normally able to excrete vast amounts of
dilute urine. Thus a normal adult can drink up to 20 liters per day of water
without becoming hyponatremic. However, the intake of solutes is also necessary
to excrete free water. Under normal circumstances, this is clinically
irrelevant. In the lack of proper solute intake, the amount of free water
excretion can be severely limited. Without adequate solute intake, the
normal functioning electrolyte gradient that pulls water into urine will be
effectively destroyed. Briefly, to excrete free water from
urine, the urine flow will equal the rate of solute excretion divided by the
urine osmolality. With a diet of only solute poor beer, only about 200-300
mOSM of solute will be excreted per day, capping the amount of free water
excretion at four liters. Any intake above 4 liters would lead to a dilution
of the serum sodium concentration and thus hyponatremia.
Any vomiting or GI absorptive problems due to alcohol intoxication can also
compound the effect of potomania due to additional electrolyte and acid-base
disturbances. Treatment
As with all cases of hyponatremia, extreme caution must be taken to avoid
the fatal consequences of rapidly correcting electrolytes. Special
considerations with the treatment of potomania are needed. Because this could
be a chronic condition, low sodium may be normal for the patient, so an
especially careful correction is warranted. It is also very important to
note that due to the normal kidney function, and lack of other intrinsic or
toxic cause of the electrolyte disturbance, restoration of dietary
solutes will correct the electrolytes to normal serum levels. This again must be
done with caution. References
Hilden, T; Svendsen, T. L.. "ELECTROLYTE DISTURBANCES IN BEER DRINKERS a Specific
'Hypo-osmolality Syndrome'". The Lancet 306: 245–6.
doi:10.1016/S0140-6736(75)90961-7. PMID 49796. )*Harrow, A. S.. "Beer potomania
syndrome in an alcoholic". Virginia medical 116: 270–1. PMID 2763635.
ellow.blogspot.com03/beer-potomania.html Berl, T.. "Impact of Solute Intake on
Urine Flow and Water Excretion". Journal of the American Society of Nephrology
19: 1076–8. doi:10.1681/ASN.2007091042. PMID 18337482.