SESSION TYPE: Critical Care Cases II
PRESENTED ON: Wednesday, October 24, 2012 at 11:15 AM - 12:30 PM
INTRODUCTION: Hyponatremia is a potentially fatal condition. Symptoms range from weakness and fatigue to seizures, coma, and even death. Causative circumstances are equally numerous and categorized on the associated volume status. Volume status, along with the degree of hyponatremia, determines the strategy to treat the patient. One such cause is excessive intake of a low-sodium liquid (i.e. beer) coupled with reduced intake of sodium, protein and other necessary nutrients, referred to as beer potomania. We present a case of profound hyponatremia.
CASE PRESENTATION: A 56 year old female brought into the emergency department, for witnessed seizure activity and minimally responsive. Over the past several days, she has been progressively confused, somnolent and waning speech and orientation. In addition, she had nausea with multiple episodes of nonbloody emesis. Patient is a heavy alcoholic, partial to beer and has not been eating well. Physical exam showed an obtunded patient with diminished responsiveness and reflexes, upper extremities in a flexed posture and withdrawing to noxious stimulus. Laboratory studies revealed a sodium level of 97 mmol/L Due to an earlier seizure and the extreme degree of hyponatremia, the patient was started on a hypertonic saline infusion. Rate was calculated for goal correction rate of about 0.5 mmol/L/hour. Laboratory panels were followed frequently in the ICU, and the rate was adjusted accordingly. Patient recovered well during the hospitalization. Her mentation was near baseline after day two and by day 7 was discharged to home.
DISCUSSION: Hyponatremia is common and often not life-threatening. Symptoms develop with levels below 125 with neurological complications occurring with sodium less than 115. However, acute and severe cases carry high mortality rates, greater than 50% when the level is less than 105. A thorough history is paramount; in this case the etiology was strongly suspected. Once the diagnosis of hyponatremia is made, the workup includes serum and urine osmolarity, urine sodium to determine volume status. In the case of beer potomania and polydypsia, sodium should correct shortly. Be wary of a rapid correction, which can result in osmotic demyelination syndrome. In cases of beer potomania, even conservative treatment can lead to this complication.
CONCLUSIONS: With due diligence and appropriate treatment, severe hyponatermia can be a survivable disease entity and can have complete recovery.
1) Sanghvi SR, Kellerman PS, Nanovic L. Beer potomania: an unusual cause of hyponatremia at high risk of complications from rapid correction. Am J Kidney Dis. 2007;50(4):673-680.
2) Campbell, M. Hyponatremia and Central Pontine Myelinolysis as a Result of Beer Potomania: A Case Report. Prim Care Companion J Clin Psychiatry. 2010; 12(4): PCC.09100936.
DISCLOSURE: The following authors have nothing to disclose: Nimesh Patel, Andrew Sacks
No Product/Research Disclosure InformationUniversity of Arizona, Sahuarita, AZ