However, the intake of solutes is also necessary to excrete free water. Although he was awake and alert, he was disoriented to time. The urine specific gravity will be low because of the effect of maximal dilution. Little or no salt content of beer results in marked reduction in the solute load to the kidney. Liamis GL, Milionis HJ, Rizos EC, Siamopoulos KC, Elisaf MS. Mechanisms of hyponatremia in alcohol patients. This is nothing new!” She told me he'd been out of work because of alcohol abuse and dependence and had moved in with her a little over 6 months ago. The symptoms of potomania are similar to other causes of hyponatremia and include dizziness, muscular weakness, neurological impairment and seizures, all related to hyponatremia and hypokalaemia. This critical sodium result triggered the lab to determine the serum osmolality to help isolate the cause of the hyponatremia, but the results weren't available yet. Your account has been temporarily locked due to incorrect sign in attempts and will be automatically unlocked in 30 mins. These patients are at serious risk of rapid decompensation secondary to hyponatremia and its neurological sequelae. Beer potomania is a syndrome of hyponatremia associated with exces-sive beer drinking. doi: 10.1097/01.NURSE.0000415301.20409.4e. Readers should verify all information and data before treating patients or implementing any therapies described in these educational activities. Freda BJ, Davidson MB, Hall PM. Educate your colleagues and vulnerable patients about this little-known condition. This leads to impaired water clearance and dilutional hyponatremia. Sterns RH. Va Med. The reintroduction of solutes, including sodium from I.V. Judiciously monitor urine output and serum sodium levels and perform frequent neurologic assessments as priority nursing interventions. Potomania 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, where the body does not have enough nutrients known as electrolytes, namely sodium, potassium, and magnesium. Chem 10; Osmolality; ADH; Evaluation. Signs and symptoms of acute hyponatremia include difficulty concentrating, confusion, lethargy, agitation, headache, seizures, anorexia, nausea, and vomiting. Sterns RH, Nigwekar SU, Hix JK. The following symptoms of beer potomania often follow an episode of binge drinking and poor nutritional intake: 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. 20. See Understanding the dangers of ODS for more information. 3 Other abnormal lab results consistent with this diagnosis include hypokalemia (mean potassium, 3 mEq/L) and low blood urea nitrogen and urine sodium levels. Special considerations with the treatment of potomania are needed. This will lead to the inability to excrete sufficient amounts of free water to keep up with the ingestion of large quantities of the hyposmolar beer. Because this could be a chronic condition, low sodium may be normal for the patient, so an especially careful correction is warranted. Greenwood Village, CO: Thomson Reuters; 2011. For immediate assistance, contact Customer Service: Wolters Kluwer Health This is challenging because underlying conditions may be masked by the alcohol ingestion, which could impact treatment. 3. Medscape. 1989; 116(6):270-1 (ISSN: 0146-3616). Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R, eds. 23. 2010. 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. By continuing to use this website you are giving consent to cookies being used. Hyponatremia. On physical assessment, I found Mr. H to be underweight and visibly malnourished, with a BMI of 16. Beer potomania is a potentially life-threatening condition in which drinking massive amounts of beer in combination with eating no or little food results in a drop in blood sodium levels and osmolality [1,2]. Presented at the Second International Course on Fluid, Electrolyte and Acid-Base Disorders in Clinical Practice, Parma, Italy, 2007. For more information, see “Managing Alcohol Withdrawal in Hospitalized Patients” (April, Nursing2012). The infusion rate is based on the hourly urine output; the replacement ratio is 0.25 to 1 mL of D5W per mL of urine due to be infused within the following hour.2 Administer thiamine as prescribed to prevent Wernicke encephalopathy. Functioning as a neuron support network, oligodendrocytes produce and maintain protective and insulating myelin sheaths for neurons. Low blood osmolality results in water retention in the kidneys and subsequently in low blood sodium levels (dilutional hyponatremia). A 65-year-old man with severe hyponatremia and alcohol abuse. Their severity depends on how quickly sodium is decreasing and cerebral edema is developing. Harrow AS. Developed from presentations at our live meetings, All About NPs & 2010. Patients with severe signs and symptoms of acute hyponatremia, such as coma and respiratory arrest, require very aggressive treatment to prevent permanent neurologic disability or death. Posted By: Ben Taylor, PA-C, PhD, DFAAPA June 12, 2020 " Beer potomania " is a syndrome used to describe patients who present with hyponatremia along with a history of excessive beer drinking. Chem 10; Osmolality; ADH; Evaluation. About 14 hours after admission, his sodium level increased to 112 mEq/L. With little food or other sources of electrolytes, consumption of large amounts of beer or other dilute alcoholic drinks leads to electrolyte disturbances, where the body does not have enough nutrients known as electrolytes, namely sodium, potassium, and magnesium. Your message has been successfully sent to your colleague. Beer potomania is a potentially life-threatening condition in which drinking massive amounts of beer in combination with eating no or little food results in a drop in blood sodium levels and osmolality [1,2].. Osmolality refers to the concentration of osmotically active solutes, which contributes to the movement of water among the fluid compartments in the body. 8. Káradóttir R, Attwell D. Neurotransmitter receptors in the life and death of oligodendrocytes. To evaluate a significant change in mental status, the healthcare provider may need to rely heavily on a comprehensive assessment and accounts of patients' activities and behavior. 12. your express consent. Micromedex Data Base. To produce 1 L of maximally dilute urine, the kidneys require 50 to 60 mOsmol of solutes.3 The patient who's chronically malnourished or protein deficient doesn't have available solutes and will have a net retention of fluid despite little or no ADH.3,4 See The role of ADH. 800-638-3030 (within USA), 301-223-2300 (international). Musana AK, Yale SH. Yeates KE, Singer M, Morton AR.
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