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Commentary and Observations from
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Hyponatremia and Alcoholism

Hyponatremia and Alcoholism

"Beer potomania" is a syndrome used to describe patients who present with hyponatremia along with a history of excessive beer drinking. These patients are at serious risk of rapid decompensation secondary to hyponatremia and its neurological sequelae. Patients will demonstrate decreased electrolytesparticularly sodium, potassium, and magnesium. The symptoms of beer potomania are related to hyponatremia and hypokalemia, and include dizziness, muscular weakness, neurological impairment, and seizures. Though the symptoms of beer potomania and other causes of hyponatremia are similar, beer potomania typically has a chronic onset, pathophysiology, and symptom presentation, and thus should be considered an independent clinical condition.

The severity of symptoms in patients with acute hyponatremia almost always reflects the severity of cerebral overhydration, which is related to the degree of hyponatremia. Seizures (typically generalized tonic-clonic) can be caused by severe and rapidly evolving hyponatremia. If plasma sodium concentration rapidly decreases to <115 mEq/L, it will generally result in these seizures.

The following symptoms of beer potomania often follow an episode of binge drinking and poor nutritional intake:

  • Acutely altered mental state
  • Muscle weakness, spasms, or cramps
  • Loss of energy or fatigue
  • Trouble walking
  • Irritability or restlessness
  • Confusion
  • Nausea or vomiting (early finding and may be seen when the serum sodium concentration falls below 125-130 mEq/L)
  • Headache, seizures, coma (occurs if the serum sodium concentration falls below 115-120 mEq/L)

Additionally, when caring for chronic alcoholics, keep in mind that hyponatremia is a common electrolyte abnormality and can be due to conditions such as cirrhosis, congestive heart failure, syndrome of inappropriate antidiuretic hormone (SIADH) secretion, and hypovolemia.

  • Sterns RH. Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med. 2015;372:55-65.
  • Yeates KE, Singer M, Morton AR. Salt and water: a simple approach to hyponatremia. CMAJ. 2004;170:365-369.

Filed under: Neurology, Substance Abuse

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