tea and toast potomania
Natasha N. Dave, MD, POCUN Associate Editor Jay Seltzer, MD José Antonio Tesser Poloni, MD, Interventional Nephrology Series A patient with normal renal function can dilute the urine to about 50 mosm/L. Uosm = Urinary osmolality. Alcohol also has a direct action as a V2 receptor antagnoist and so we pee a lot when we drink beer, further worsening the hyponatremia. Can you please contact me via jon.brassey[@]gmail.com, FWC = V ( 1 – Uosm/Sosm )EFWC = V [ 1 – (UK+ UNa)/SNa ]. Beer contains a lot of free water with very little salt and protein (one liter of beer contains only 30 mg of sodium). A normal diet generates around 750 mosm of solute per day. This is important because the limit on how much free water excretion can be achieved in a day is dependent on urine osmolality (urine flow rate = rate of solute excretion / urine osmolality). Abhilash Koratala, MD, Series Leaders  Kelly Hyndman, PhD (Basic Science) Tag: tea and toast potomania. Dominique Tomacruz, RFN Editors Vighnesh Walavalkar, MD Anna Gaddy, MD (2020-2022) Dont forget your salted nuts with next dose of beer. There is a minimum osmolality that the fluid has to have for the kidneys to excrete it. Some sources cite a minimum urine osmolality of 60 m Osm/L. I run the TRIP Database (www.tripdatabase.com) and am keen to make contact to discuss a project which might be mutually beneficial. Kasey Belanger Edgar Lerma, MD, Let’s Talk About Peritoneal Dialysis http://medicalopedia.org/1361/beer-potomania-syndrome-2/, Focus on POCUN (Point of Care Ultrasound in Nephrology). How does beer potomania work? Now take a case of beer potomania where the person has a very low protein and sodium diet. Enter Tea and Toast. Mental Disorder. Solute excretion is the amount of solute consumed which is to be excreted in urine. Some sources cite a minimum urine osmolality of 60 m Osm/L. How do you share with a heavy beer drinker that this is his fate? Danwen Yang, MD, Focus on POCUN (Point of Care Ultrasound in Nephrology) However, if the intake of solutes decreases to 600 mOsm/d, 8 L can be excreted, and in the more extreme setting in which the intake decreases to only 300 mOsm/d, a mere 4 L of free water can be excreted. Remember the “osm” in urine osmolarity consists of urea ( from dietary protein) and also sodium. However, if the intake of solutes decreases to 600 mOsm/d, 8 L can be excreted, and in the more extreme setting in which the intake decreases to only 300 mOsm/d, a mere 4 L of free water can be excreted. People who suffer from it usually drink between six and ten or  fifteen liters of water per day. Thanks for correcting me and thanks a ton for the post. Our kidneys cannot simply excrete free water. 200 mosm/(50 mosm/L)= 4 liters. the facts speak for themselves, but one cant speak with the beer drinker! Jeremie Lever, Pediatric Nephrology Series J Am Soc Nephrol. The calcluation is 750 mosm/( 50 mosm/L)= 15 L. This is the classic form of psychogenic polydipsia and this is why a quantity of 15 liters is often quoted when asked about the maximum amount of water one can drink in a day before becoming hyponatremic. Tea and toast” and “beer potomania refer to diets that are severely deficient in solute load but high in free water. nr1215, a V2 receptor antagonist would increase water excretion, but that would increase not decrease the serum Na. An intake of fluids that exceeds this volume will culminate in hyponatremia.” JASN 2008. Normal solute intake is 10mOsm solute per kg body weight per day, or 600 mOsm/day in a 60 kg individual. For an individual drinking predominantly beer, they are taking in only about 300mosm of solute per day, which is then eliminated in the urine. Anthony Chang, MD Alexander Gallan, MD, Landmark Nephrology After the 15th liter of urine there is no longer any solute left to excrete the 16the liter and it is retained. They go on to explain that the equation above “not only reflects the well-established fact that as the urinary osmolality (Uosm) decreases the free water clearance commensurately increases but emphasizes that for any given Uosm it is the solute excretion that sets the ceiling as to how much free water will be excreted. KTA Priti Meena, MD To be more precise, we are using the EFWC and not FWC as we want to ‘ignore’ the non osmotic molecules from the picture. A beer diet consists of mostly carbohydrate but little sodium or protein. The same general mechanisms (low solute intake, high fluid intake) are also at play in elderly women eating a “tea and toast” diet. Crystal Farrington, DO Potomania could also be defined as a disorder in impulse control, characterized by excessive water intake. Elinor Mannon (2020-2022) Services. SIADH (urine Na >20mmol) Malignancy (lung, pancreas, prostate, lymphoma, others) Each liter of urine contains the minimum amount of solute at 50 mosm. On top of this mechanism, beer drinkers may also have non-osmotic secretion of ADH as a result of volume depletion from chronic GI losses or vomiting. Dearbhla Kelly, MBBch (2020-2022), RFN Faculty Lead Tea-and-toast or beer potomania hyponatremia occur when low solute intake limits the ability of the kidneys to produce urine that maintains electrolyte homeostasis. “The decision to move to a retirement home is possibly one of the most difficult a person can make, and how to find the right retirement residences in Ottawa can be overwhelming. 2008 Jun;19(6):1076-8. Beer potomania (excessive beer intake with reduced solute intake) Elderly patients who eat a “tea-and-toast” diet, anorexia (low solute intake) hypovolemia Non-renal losses GI loss (vomiting, diarrhea, gastric tube drainage) Hemorrhage; Sweating, burns; Renal losses Diuretics (esp ecially thiazides) Post-obstructive diuresis; Cerebral salt wasting The potomania is  an impulsive desire to drink water all the time and can have very serious consequences. Cheers!! Preethi Sekar, MD What are Drugs Tolerance and its effects? Kammi Henriksen, MD Potomania: Symptoms, Causes and Treatments. It occurs frequently  in patients with schizophrenia or other chronic psychiatric illnesses. I think of it this way. https://www.ncbi.nlm.nih.gov/pubmed/18337482, Designed by Elegant Themes | Powered by WordPress. Therefore, if a patient like this drinks more than 15 liters of fluid per day he will become hyponatremic because he can’t excrete any more than 15 liters of urine per day. Gautam Phadke, MD One of the admittedly rare causes of hyponatremia is beer potomania–the excessive consumption of beer in the absence of much food. Brian Stotter, Skeleton Key Group shall we call this the catch 22 of potomania….statistics and solutions abound but when ones life sit is the source of all these facts and figures its a fair mile from any real help….su, for better info visit:http://medicalopedia.org/1361/beer-potomania-syndrome-2/. Tea and toast” and “beer potomania refer to diets that are severely deficient in solute load but high in free water. i have a question. Leonardo Riella, MD (Kidney Transplantation), Faculty Advisors Our kidneys cannot simply excrete free water. Comments. Save my name, email, and website in this browser for the next time I comment. Juan Carlos Velez, MD Pravir V. Baxi, MD Bhavnish Bucktowarsing, MD The take-home point is that if water ingestion exceeds the amount that can be cleared with the solute excretion at the minimum allowed urinary osmolality, then fluid retention will happen, causing hyponatremia. Abhilash Koratala, MD, Home Hemodialysis Series The amount of free water we excrete depends upon number of osmoles that need to be excreted. Matthew A. Sparks, MD, FASN, FAHA This puts a cap of only about 4-5 Liters of electrolyte-free water that can be excreted in a day. Madhuri Ramakrishnan, MD, Basic Science Series 3. […], Potomania: Symptoms, Causes and Treatments, The Most Important Types of Depression Symptoms, Mythomania Symptoms, Causes and Treatment. Further Reading Nikhil Agrawal, MD Beer has a very low content of sodium and protein–and if an individual subsists solely on beer they have a very limited solute intake. Three facts contribute to beer potomania: 1. The kidneys can dilute urine to a maximum of 50 mosm/L Free water clearance (cH2O). Eryn E. Dixon Samira Farouk, MD, MS, FASN, Social Media Associate Editor Aisha Shaikh, MD If he drinks a 5th liter there is no solute left to allow excretion of the 5th liter and he becomes hyponatremic. Sayna Norouzi at a urinary osmolality as low as 60 mOsm/kg if solute intake is 900 mOsm/d, 12 L of free water will be excreted. I presented it other way around. Amy is so knowledgeable and thorough that stress was completely removed. If you hold that to be the minimum osmolality, the JASN 2008 article derives the following formula which can be used to estimate how much solute a person needs to consume to excrete a certain number of liters of water. Tea and toast diet, Beer potomania; Psychogenic polydipsia (>15 L/Day if normal kidneys) Iatrogenic water overload in ED; Amphetamines; Exercise-Associated Hyponatraemia; Urine osmolality > serum osmolality. ADH independent causes: Psychogenic (primary) polydipsia; renal failure (can’t get rid of water); If low solute intake like “tea and toast”, or beer potomania → not enough solute intake to make urine and excrete free water Impact of solute intake on urine flow and water excretion. Gearoid McMahon, MB, BCh, Click here for bios of RFN Editorial Board. The potomania is an impulsive desire to drink water all the time and can have very serious consequences. How to Stop Biting Your Nails in 10 Steps, 10 Keys How to Convince Someone of Anything, List of Sleep Disorders Treatment and Symptoms.


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