II. Pathophysiology
- Water Intoxication, beer potomania, Tea and Toast Syndrome share a similar mechanism for Hyponatremia
- Patient with excessive hypoosmolar fluid intake (free water, beer, tea) and low solute diet (low Sodium intake)
- Intake exceeds the renal capacity for free water excretion (50 to 100 meq/L or mOsm/L, specific gravity <1.003)
- Example: Normal Patient
- Patient ingests 600 mOsms solute (e.g. salt, Potassium) per day (10 mOsm/kg/day for a 60 kg person)
- If urine most dilute at 50 mEq/L, they could excrete 12 liters worth of free fluid intake without Hyponatremia
- However, renal excretion of dilute urine would be overwhelmed at 13 liter intake, and Hyponatremia would begin
- Example: Low solute intake (e.g. beer potomania, Tea and Toast Syndrome)
- Patient ingests only 100 mOsms solute per day (the remainder is beer, tea)
- Renal excretion of dilute urine is overwhelmed at only 2 Liters/day
- Example: Exercise Associated Hyponatremia
- Extrarenal Solute Losses Replaced with Free Fluid
- Excessive extrarenal losses (e.g. sweating) replaced with large volume of free fluid intake
III. Causes
- See Exercise Associated Hyponatremia
- Water Intoxication (Psychogenic Polydipsia)
- Free water intake exceeds free water excretion
- Seen in Psychosis (Schizophrenia, Bipolar Disorder)
- Beer Potomania Syndrome
- Excessive Alcohol intake (esp. beer) and low solute dietary intake
- Tea and Toast Syndrome (esp. elderly)
- Diet lacking in salt and Protein but with excessive oral free water intake
- Compounded by the typically low Glomerular Filtration Rate (GFR) in the elderly (increases fluid reabsorption)
-
Hypotonic Saline infusion
- Affects 4-5% of post-operative patients
-
Methylenedioxymethamphetamine (MDMA, Ecstasy, Molly)
- May result in Water Intoxication to point of severe Hyponatremia (deaths have occurred)
IV. Findings
- See Hyponatremia
V. Labs
- See Isovolemic Hypoosmolar Hyponatremia
- See Hyponatremia
- Diagnosis
- Hyponatremia
- Hypoosmolality
- Normal extracellular fluid (normovolemic)
- Urine Sodium < 10 (Urine Osmolality <100 mOsm/kg, maximally dilute urine)
VI. Differential Diagnosis
VII. Management
VIII. References
- Glaser (2022) EM:Rap 22(6): 9-11
- Peechakara (2022) Water Toxicity, StatPearls, Treasure Island, accessed online 6/2/2022
- Lodhi (2017) Cureus 9(12): e2000 [PubMed]
- Miller (2023) Am Fam Physician 108(5): 476-86 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | A condition resulting from the excessive retention of water with sodium depletion. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D014869 |
| SnomedCT | 71785001 |
| English | Water Intoxication, WATER INTOXICATION, WATER INTOX, Water Intoxication [Disease/Finding], water intoxication, Water intoxication, Water intoxication syndrome, Water intoxication syndrome (disorder), intoxication; water, water; intoxication |
| German | WASSERINTOXIKATION, Wasserintoxikation |
| Japanese | 水中毒, ﾐｽﾞﾁｭｳﾄﾞｸ |
| Swedish | Vattenförgiftning |
| Czech | intoxikace vodou, Intoxikace vodou |
| Finnish | Vesimyrkytys |
| Russian | VODNAIA INTOKSIKATSIIA, ВОДНАЯ ИНТОКСИКАЦИЯ |
| Portuguese | INTOXICACAO HIDRICA, Intoxicação hídrica, Intoxicação por Água |
| Spanish | INTOXICACION ACUOSA, Envenenamiento por Agua, síndrome de hiperhidratación hipotónica (trastorno), síndrome de hiperhidratación hipotónica, Intoxicación hídrica, Intoxicación por Agua |
| French | INTOXICATION PAR L'EAU, Intoxication par l'eau, Intoxication hydrique, Syndrome d'intoxication par l'eau |
| Polish | Zatrucie wodne |
| Hungarian | Víz intoxicatio |
| Norwegian | Vannforgiftning, Vannintoksikasjon |
| Dutch | intoxicatie; water, water; intoxicatie, waterintoxicatie, Intoxicatie, water-, Schwartz-Bartter syndroom, Waterintoxicatie |
| Italian | Intossicazione da acqua |
Ontology: Psychogenic polydipsia (C0395005)
| Definition (MSH) | A clinical disorder characterized by excessive fluid intake (polydipsia); HYPONATREMIA; and POLYURIA in SCHIZOPHRENIA and other psychiatric disorders. Impaired water metabolism in psychogenic polydipsia can result in WATER INTOXICATION. |
| Concepts | Mental or Behavioral Dysfunction (T048) |
| MSH | D059607 |
| SnomedCT | 192018009, 82800008, 15945005 |
| German | psychogene Polydipsie, Polydipsie, primäre, Polydipsie, primaere, Polydipsie, psychogene, Polydipsie psychogen |
| Japanese | 心因性多飲症, ｼﾝｲﾝｾｲﾀｲﾝｼｮｳ |
| English | psychogenic water drinking, psychogenic water drinking (diagnosis), Polydipsia psychogenic, psychogenic polydipsia, primary polydipsia, compulsive water drinking, polydipsia psychogenic, Psychogenic Polydipsias, Psychogenic Polydipsia, Polydipsia, Primary, Primary Polydipsias, Polydipsias, Primary, Polydipsia, Psychogenic, Polydipsias, Psychogenic, Primary Polydipsia, Polydipsia, Psychogenic [Disease/Finding], Primary polydipsia, Psychogenic polydipsia (disorder), Psychogenic polydipsia |
| Czech | Polydipsie psychogenní, Psychogenní polydipsie, psychogenní polydipsie, psychogenní žízeň |
| Hungarian | Psychogen polydipsia, Pszihogén polydipsia |
| French | Polydipsie primitive, Potomanie, Polydipsie psychogène, Polydipsie primaire |
| Portuguese | Polidipsia Psicogênica, Polidipsia psicogénica |
| Russian | ПОЛИДИПСИЯ ПЕРВИЧНАЯ, POLIDIPSIIA PSIKHOGENNAIA, POLIDIPSIIA PERVICHNAIA, ПОЛИДИПСИЯ ПСИХОГЕННАЯ |
| Spanish | Polidipsia Psicogénica, polidipsia primaria (trastorno), polidipsia primaria, polidipsia psicogéna (trastorno), polidipsia psicogéna, polidipsia psicogénica, polidipsia psicógena (trastorno), polidipsia psicógena, Polidipsia psicógena |
| Polish | Polidypsja psychogenna |
| Italian | Polidipsia psicogena, Polidipsia primaria |
| Norwegian | Primær polydipsi, Psykogen polydipsi |
| Dutch | psychogenetische polydipsie |
