Beer Potomania—An Unusual Cause of Hyponatremia

Kujubu, Dean A.; Khosraviani, Ardeshir

doi:10.7812/tpp/14-181

Cited by 9 publications

(17 citation statements)

References 10 publications

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“…In order to produce 1 liter of maximally dilute urine, the kidneys require 50 mOsmol of solutes. This solute load is produced by urea generated from protein breakdown (10 g of protein produces around 50 mOsm of urea) [4]. Dietary sodium and potassium make up the remaining portion of the solute load.…”

Section: Discussionmentioning

confidence: 99%

Acute Severe Hyponatremia as a Serious Health Implication of Herbal Detox Regimens

Soliman

Fuller

Usmani

et al. 2018

Cureus

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Hyponatremia is a serious health problem and can cause substantial morbidity and mortality as a result of osmotically induced cerebral edema if left untreated. Also, inappropriate rapid correction of chronic cases of hyponatremia can lead to osmotic demyelination with neurological impairment and death as consequences. It is defined as a serum sodium concentration less than 135 mmol/L.Herbal detox regimens are gaining popularity with their easy access over the counter and not well studied adverse effects. We hereby present a case of a 67-year-old man who developed severe hyponatremia after starting a five-day kidney detox regime.This regime consisted of drinking over a gallon (128 oz) of fluid daily, herbal tea with Uva Ursi leaves, juniper berries and several other ingredients. On the last day of this detox regime, he presented to the emergency department with a critical serum sodium level of 111 mmol/L associated with neurological symptoms. The purpose of this case report is to highlight the potential serious adverse effects associated with what is considered benign herbal medicine.

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Section: Discussionmentioning

confidence: 99%

Acute Severe Hyponatremia as a Serious Health Implication of Herbal Detox Regimens

Soliman

Fuller

Usmani

et al. 2018

Cureus

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“…A person with normal renal function and normal dietary intake removes about 600-900 mOsm/day. With the maximal urinary dilation of 50 mOsm/L, a person can excrete about 20 L of water without becoming hyponatremic, allowing for broad range of water intake (reaching up to 20 L) [ 5 - 7 ]. As free-water clearance in a person with normal diluting capacity is dependent on osmole excretion, a decrease in daily dietary osmole intake can have a vast decrease in the excretory capacity of the kidney.…”

Section: Discussionmentioning

confidence: 99%

“…In our two cases, patients with nine to 20, 12 oz cans of beer daily, their approximate osmole intake was 225-250 mOsm/L per day. Assuming normal urinary dilation capability, any fluid intake more than 3-4 L will result in water retention and subsequently dilutional hyponatremia in these patients [ 4 - 5 ]. In beer potomania patients, the ability to reabsorb free-water from the collecting tubules is decreased due to suppressed antidiuretic hormone [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patient’s unremarkable physical examination, together with clear chest x-ray and no significant abnormality on echocardiogram, made it easier to rule out congestive heart failure. Considering the patient’s history (of chronic alcohol abuse and recent seizure), clinical presentation (of lethargy and malnourishment), lab values (of low serum osmolarity, urinary osmolarity, urinary sodium level), and absence of any other plausible explanation, directed us to establish the diagnosis of beer potomania syndrome [ 4 - 5 ].…”

Section: Case Presentationmentioning

confidence: 99%

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“Beer Potomania” – A Syndrome of Severe Hyponatremia with Unique Pathophysiology: Case Studies and Literature Review

Lodhi¹,

Saleem²,

Kuzel³

et al. 2017

Cureus

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Beer potomania, a unique syndrome of hyponatremia, was first reported in 1972. It is described as the excessive intake of alcohol, particularly beer, together with poor dietary solute intake that leads to fatigue, dizziness, and muscular weakness. The low solute content of beer, and suppressive effect of alcohol on proteolysis result in reduced solute delivery to the kidney. The presence of inadequate solute in the kidney eventually causes dilutional hyponatremia secondary to reduced clearance of excess fluid from the body. Early detection of hyponatremia due to beer potomania in the hospital is necessary to carefully manage the patient in order to avoid neurological consequences as this syndrome has unique pathophysiology. We are reporting two cases, presenting to the emergency department with severe hyponatremia. After a detailed initial evaluation of the patients and labs for hyponatremia, a diagnosis of beer potomania was established in both cases. Considering the unique pathophysiology of beer potomania syndrome, the patients were closely monitored and treated appropriately to prevent any neurological sequelae.

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“…The extreme manifestation of this is the rare condition of beer potomania, in which alcoholics who drink large amounts of fluid that is low in electrolytes, and have minimal protein intake, develop hyponatremia despite a normal urinary diluting ability [3,4,5,6,7,8,9,10,11,12]. This has also been described in patients on extreme weight-reducing diets that are very low in protein and high in water intake (e.g.…”

Section: Low Solute Intake Is An Underrecognized Cause Of Hyponatremiamentioning

confidence: 99%

Current Challenges in the Evaluation and Management of Hyponatremia

McGreal¹,

Budhiraja²,

Jain³

et al. 2016

Kidney Dis

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Background: Hyponatremia is a common electrolyte imbalance that clinicians face on a regular basis. Summary: This review aims to discuss four current challenges that can arise when diagnosing and treating hyponatremia: low solute intake, heart failure, exercise-associated hyponatremia, and mild chronic hyponatremia. Low solute intake in a person who already has a urinary concentrating defect will lead to increased retention of free water. The free water retention will cause or worsen hyponatremia that is already present. Low solute intake is overlooked in patients with other disease processes that can cause hyponatremia, such as liver disease or heart failure. Heart failure and hyponatremia present their own set of challenges specifically with treatment as there are limited options. The newer class of aquaretics allows for the short-term treatment of hyponatremia. Exercise-associated hyponatremia is a phenomenon that has been described in ultra-endurance athletes. This happens when a person drinks a significant amount of water while exercising in the setting of antidiuretic hormone production from prolonged exercise. This acute drop in sodium must be treated with hypertonic saline. The term asymptomatic mild chronic hyponatremia is no longer valid. Mild chronic hyponatremia carries an increased risk of falls and fractures, specifically in the elderly populations. Key Message: In summary, hyponatremia is a multifaceted disease and presents many challenges for physicians treating it.

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Beer Potomania—An Unusual Cause of Hyponatremia

Cited by 9 publications

References 10 publications

Acute Severe Hyponatremia as a Serious Health Implication of Herbal Detox Regimens

Acute Severe Hyponatremia as a Serious Health Implication of Herbal Detox Regimens

“Beer Potomania” – A Syndrome of Severe Hyponatremia with Unique Pathophysiology: Case Studies and Literature Review

Current Challenges in the Evaluation and Management of Hyponatremia

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