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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/07/29 11:43:41」(JST)

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Not to be confused with Dipsomania.

Potomania, also known as beer potomania and beer drinkers hyponatremia, 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. The symptoms of potomania are similar to other causes of hyponatremia and include dizziness, muscular weakness, neurological impairment and seizures, all related to hyponatraemia and hypokalaemia. While the symptoms of potamania are similar to other causes of hyponatremia and acute water intoxication, it should be considered an independent clinical entity due to the often chronic nature of onset, pathophysiology, and presentation of symptoms.

Pathophysiology[edit]

The normal human kidney, through suppression of anti-diuretic hormone, is normally able to excrete vast amounts of dilute urine. Thus a normal adult can drink up to 20 liters per day of water without becoming hyponatremic. However, the intake of solutes is also necessary to excrete free water. Under normal circumstances, this is clinically irrelevant. In the lack of proper solute intake, the amount of free water excretion can be severely limited. Without adequate solute intake, the normal functioning electrolyte gradient that pulls water into urine will be effectively destroyed.

Briefly, to excrete free water from urine, the urine flow (which is solute clearance + free water clearance) will equal the rate of solute excretion divided by the urine osmolality. With a diet of only solute poor beer, only about 200-300 mOSM (normal 750mOSM to greater than 900mOSM) of solute will be excreted per day, capping the amount of free water excretion at four liters. Any intake above 4 liters would lead to a dilution of the serum sodium concentration and thus hyponatremia.

Any vomiting or GI absorptive problems due to alcohol intoxication can also compound the effect of potomania due to additional electrolyte and acid-base disturbances.

Treatment[edit]

As with all cases of hyponatremia, extreme caution must be taken to avoid the fatal consequences of rapidly correcting electrolytes (e.g. Central pontine myelinolysis, edema). Special considerations with the treatment of potomania are needed. Due to the fact this could be a chronic condition, low sodium may be normal for the patient, so an especially careful correction is warranted. It is also very important to note that due to the normal kidney function, and lack of other intrinsic or toxic cause of the electrolyte disturbance, restoration of dietary solutes will correct the electrolytes to normal serum levels. This again must be done with caution.

References[edit]

Lancet. 1975 Aug 9;2(7928):245-6. Electrolyte disturbances in beer drinkers. A specific "hypo-osmolality syndrome".
http://linkinghub.elsevier.com/retrieve/pii/S0140-6736%2875%2990961-7?showall=true
http://www.ncbi.nlm.nih.gov/pubmed/2763635
http://renalfellow.blogspot.com/2009/03/beer-potomania.html
J Am Soc Nephrol 19: 1076–1078, 2008. Impact of Solute Intake on Urine Flow and Water Excretion (http://jasn.asnjournals.org/content/19/6/1076.full.pdf+html)

UpToDate Contents

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1. 成人における低ナトリウム血症の原因 causes of hyponatremia in adults
2. 低ナトリウム血症を有する成人の評価 evaluation of adults with hyponatremia

English Journal

Treating profound hyponatremia: a strategy for controlled correction.

Sterns RH, Hix JK, Silver S.SourceRochester General Hospital, Nephrology Division, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. richard.sterns@rochestergeneral.org
American journal of kidney diseases : the official journal of the National Kidney Foundation.Am J Kidney Dis.2010 Oct;56(4):774-9. Epub 2010 Aug 14.
An alcoholic patient presented with profound hyponatremia (serum sodium concentration, 96 mEq/L) caused by the combined effects of a thiazide diuretic, serotonin reuptake inhibitor, beer potomania, and hypovolemia. A computed tomographic scan of the brain was indistinguishable from one obtained 3 we
PMID 20709440

Central pontine and extrapontine myelinolysis: from epileptic and other manifestations to cognitive prognosis.

Odier C, Nguyen DK, Panisset M.SourceNeurology Division, Department of Medicine, Montreal University Health Centre (CHUM), CHUM-Hopital Notre-Dame, 1560 rue Sherbrooke Est, Montreal, QC, Canada.
Journal of neurology.J Neurol.2010 Jul;257(7):1176-80. Epub 2010 Feb 11.
The objective of this study is to review the presentation, outcome and aetiology of central pontine and extrapontine myelinolysis (CPEPM) in a tertiary hospital center. The study method is a case series and included identification of patients from University of Montreal Health Centre archives databa
PMID 20148334