A case of hyponatremia due to beer potomania followed by acute kidney injury

Introduction: Beer potomania is a syndrome of severe hyponatremia that occurs due to inadequate daily solute intake and excessive beer consumption. The correction of serum sodium levels is a challenge for physicians, particularly in cases complicated by acute kidney injury (AKI). However, intermittent renal replacement therapy (IRRT) in patients with beer potomania and AKI can lead to over-correction of serum sodium levels and possibly result in osmotic demyelination syndrome (ODS). Here we present a case of continuous renal replacement therapy (CRRT) in which a 5% glucose solution was used to adjust the sodium concentration in the dialysate. Description: A 32-year-old man with a history of heavy drinking was admitted to a nearby hospital. A routine outpatient blood panel showed that his serum sodium, creatinine, and blood urea nitrogen levels were 104 mEq/L, 17.1 mg/dL, and 129 mg/dL, respectively. The patient was transferred to our hospital for the treatment of hyponatremia and AKI classified as KDIGO stage 3. The consciousness level of the patient was GCS 15. In order to prevent ODS due to the rapid correction of serum sodium level during IRTT, we performed CRRT and adjusted the sodium concentration in the dialysate to 118-133 mEq/L by adding a 5% glucose solution. Serum sodium level was increased < 7 mEq/L/day, and the serum sodium level was increased to 130 mEq/L on the fifth day of admission. On the sixth day, the patient began receiving intermittent hemodialysis three times a week using a non-adjusted dialysate solution with a sodium concentration of 140 mEq/L. On the 12th day of admission, the patient had a serum creatinine level of 2.3 mg/dL and a daily urine output of 950 mL; therefore, he began weaning off of hemodialysis. On the 19th day of admission, the patient was transferred to a nearby psychiatric hospital without any complications. Discussion: We performed CRRT using dialysate with adjusted sodium concentrations for a patient with severe hyponatremia and AKI. The serum sodium level was slowly corrected, and the patient had no complications from ODS. This outcome suggests that CRRT using dialysate with adjusted sodium concentrations may be useful for cases of severe hyponatremia with AKI.