BEER POTOMANIA - 2 CASES AND REVIEW OF THE LITERATURE

The association of severe hyponatremia and the ingestion of large quan tities of beer, termed beer potomania, has been known for several year s. We report two new cases, and review 20 others from the medical lite rature. These patients usually have a history of binge beer drinking, poor dietary intake, and then present with severe hyponatremia and var ious mental status changes or seizures, Typical laboratory findings in clude hyponatremia, hypokalemia, and a very dilute urine. The patients respond quickly to the administration of sodium chloride containing I V fluids. We propose that the pivotal pathophysiologic mechanism in be er potomania syndrome is the minimal intake of solute and the hypoosmo lality of the beer ingested. This will lead to the inability to excret e sufficient amounts of free water to keep up with the ingestion of la rge quantities of the hyposmolar beer. Treatment with isotonic sodium chloride results in the rapid clearance of the accumulated excess free water.