Another common clinical setting for symptomatic hyponatremia is psychogenic polydipsia. If renal diluting capability is intact, a normal individual can theoretically excrete up to 20 l/day, so that development of hyponatremia without elevated plasma ADH levels requires an intake of over 20 l/day in a 60-kg adult. In practice, most patients with psychogenic polydipsia who develop hyponatremia have ingested substantially less water; rather, they have an abnormal urinary diluting capacity with elevated plasma ADH levels, and many are schizophrenic. Beer potomania is a variation of psychogenic polydipsia, where the hyponatremia is associated with massive ingestion of beer, poor nutrition, impaired urinary dilution, and probable low plasma ADH levels.
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