Figure 1. Mechanisms involved in patient’s presentation. (A) Beer has low sodium and protein + poor diet = low total body solute. Low body solute leads to hypotonic hyponatremia. ADH is suppressed. Water is excreted in urine → leads to low urine osmolality (usually < 100). Solute is less in urine → leads to low urine Na (usually < 20). (B) Loop diuretics lead to increase excretion of Na → also leads to increase in urine osmolality. (C) K sparing diuretics lead to increase excretion of Na → also leads to increase in urine osmolality. B + C leads to increase in urine Na to 20 and urine osmolality to 223 in our case.