Patients presenting with unexplained hyponatremia? Don’t forget to ask about hard seltzer
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Hyponatremia in alcoholic patients is not a new concept, beer potomania has been part of literature and clinical practice for long. ... With increasing prevalence of hard seltzer consumption, an increase in the cases of hyponatremia can be expected.
—The lead researchers, via the International Journal of Clinical and Medical Cases
Hard seltzers have earned a reputation as the better-for-you alcoholic beverage—lower in calories and carbs and often perceived as a healthier alternative to beer. But a newly described syndrome suggests there may be an underrecognized downside to excessive consumption.
Researchers recently reported a series of patients who developed severe symptomatic hyponatremia, including seizures, after drinking large quantities of hard seltzer, prompting them to propose a new diagnosis: Mehandru/Vachharajani Syndrome.[]
While the condition appears to share similarities with beer potomania, the growing popularity of hard seltzers means it’s a diagnosis that may increasingly show up in primary care practices, urgent care centers, and emergency departments.
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The syndrome was described by researchers at Hackensack Meridian Jersey Shore University Medical Center, who reported three patients presenting with severe symptomatic hyponatremia after chronic, high-volume hard seltzer consumption.[]
According to the case series, the patients consumed an average of two or more six-packs of hard seltzer daily and presented with neurologic symptoms, including seizures. Serum sodium levels ranged from 96 to 112 mEq/L.[]
The proposed mechanism resembles that of beer potomania, a well-established cause of hyponatremia in patients who consume large amounts of low-solute alcoholic beverages while maintaining a poor diet.[]
Hard seltzers contain minimal sodium and protein, limiting the kidneys’ ability to excrete excess free water. As water intake exceeds renal excretory capacity, serum sodium can decline to dangerous levels.[]
The result can be a spectrum of symptoms ranging from nausea, headache, and confusion to seizures, coma, and potentially death if left untreated.[]
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While the report is limited to a small case series, the clinical implications may be broader than they first appear. Hard seltzers remain particularly popular among younger adults, many of whom may not fit the traditional profile of patients at risk for alcohol-related electrolyte disorders.[]
For family physicians and internists, the most important takeaway is to ensure you ask about the type of alcohol a patient consumes. A social history documenting alcohol use may not reveal the volume of hard seltzer intake that could be contributing to unexplained hyponatremia.
“Hyponatremia in alcoholic patients is not a new concept, beer potomania has been part of literature and clinical practice for long,” the lead researchers note in the case series. “With increasing prevalence of hard seltzer consumption, an increase in the cases of hyponatremia can be expected.”[]
As hard seltzer consumption remains widespread, Mehandru/Vachharajani Syndrome may become another diagnosis for clinicians to consider when evaluating patients with severe hyponatremia, altered mental status, or new-onset seizures.
Related: Are hard seltzers a healthier alcoholic beverage?