Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
권호 표지
DOI QR코드

DOI QR Code

A case of chronic licorice intoxication-induced apparent mineralocorticoid excess syndrome

만성 감초 중독으로 유발된 미네랄코르티코이드 과잉증후군 1예

  • Young Jae Lim (Department of Emergency Medicine, Dong-A University Hospital) ;
  • Ji Eun Kim (Department of Emergency Medicine, Dong-A University Hospital)
  • 임영재 (동아대학교병원 응급의학과) ;
  • 김지은 (동아대학교병원 응급의학과)
  • Received : 2023.11.13
  • Accepted : 2023.12.04
  • Published : 2023.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Licorice is a perennial herb belonging to the legume family that mainly grows in northeastern China, Mongolia, Siberia, and other regions. It is used in traditional medicine in the form of dried roots in the East and the West. The main active component of licorice, glycyrrhizin, is known to produce mineralocorticoid effects when consumed chronically, which can lead to apparent mineralocorticoid excess syndrome. Herein, we present the case of a 72-year-old woman who was admitted to the emergency room with severe generalized weakness and difficulty keeping her neck upright, which had developed after daily consumption of licorice-infused water for the past 2 months. Blood tests revealed metabolic alkalosis and severe hypokalemia, and an electrocardiogram showed ventricular bigeminy. The patient was treated with daily potassium and spironolactone supplements, leading to a significant improvement in muscle strength after a week. One week later, the patient was discharged, showing rare ventricular premature contractions on electrocardiography, but with no specific complaints. Chronic licorice ingestion leading to hypokalemia and muscle weakness can be life-threatening, necessitating the discontinuation of the causative agent, close monitoring, and cautious supplementation of potassium and spironolactone as treatment.

Keywords

Acknowledgement

Fig. 2를 작성해 주신 정진우 박사님께 감사드린다.

References

  1. Park YC, Lee S, Lee IS. Pharmalogical effects and toxicity of licorice. J Toxicol Pub Health 2002;18:301-9.
  2. Gallacher SD, Tsokolas G, Dimitropoulos I. Liquorice-induced apparent mineralocorticoid excess presenting in the emergency department. Clin Med (Lond) 2017;17:43-5. https://doi.org/10.7861/clinmedicine.17-1-43
  3. Hong HI, Han KH, Hwang JW, Kim YD, Shim MS, Kim JY. A case of licorice induced hypokalemic paralysis with rhabdomyolysis. J Korean Soc Endocrinol 2005;20:179-82. https://doi.org/10.3803/jkes.2005.20.2.179
  4. Conn JW, Rovner DR, Cohen EL. Licorice-induced pseudoaldosteronism: hypertension, hypokalemia, aldosteronopenia, and suppressed plasma renin activity. JAMA 1968;205:492-6. https://doi.org/10.1001/jama.205.7.492
  5. Russo S, Mastropasqua M, Mosetti MA, Persegani C, Paggi A. Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol 2000;20:145-8. https://doi.org/10.1159/000013572
  6. Piette AM, Bauer D, Chapman A. Major hypokalemia with rhabdomyolysis secondary to the intake of a nonalcoholic aniseed aperitif. Ann Med Interne (Paris) 1984;135:296-8.
  7. Eriksson JW, Carlberg B, Hillorn V. Life-threatening ventricular tachycardia due to liquorice-induced hypokalaemia. J Intern Med 1999;245:307-10. https://doi.org/10.1046/j.1365-2796.1999.00476.x
  8. Han EJ, Park JS. Lethal arrhythmia induced by licorice. J Korean Med Sci 2023;38:e107. https://doi.org/10.3346/jkms.2023.38.e107
  9. Gennari FJ. Hypokalemia. N Engl J Med 1998;339:451-8. https://doi.org/10.1056/nejm199808133390707
  10. Rimmer JM, Horn JF, Gennari FJ. Hyperkalemia as a complication of drug therapy. Arch Intern Med 1987;147:867-9. https://doi.org/10.1001/archinte.1987.00370050063011