Shoshin beriberi - a fulminant form of cardiovascular beriberi - and severe hyponatraemia were observed concomitantly in a heavy beer drinker. Hyponatraemia due to water overload and not to sodium deficiency is not a feature of the true beer drinker syndrome. Cardiogenic shock with major lactic acidosis developed. This case confirms the remarkable effectiveness of thiamine and the ineffectiveness of cardiotonic and vasoconstrictive drugs in such cases.