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Malicious Licorice

2008; Lippincott Williams & Wilkins; Volume: 117; Issue: 13 Linguagem: Inglês

10.1161/circulationaha.107.733097

1524-4539

Ivan Tancevski, Kathrin Eller, Michael Spiegel, Rudolf Kirchmair, Josef R. Patsch,

Ion Transport and Channel Regulation

HomeCirculationVol. 117, No. 13Malicious Licorice Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBMalicious Licorice Ivan Tancevski, MD, Philipp Eller, MD, Michael Spiegel, MD, Rudolf Kirchmair, MD and Josef R. Patsch, MD Ivan TancevskiIvan Tancevski From the Department of Internal Medicine (I.T., P.E., R.K., J.R.P.) and Department of Neurology (M.S.), Innsbruck Medical University, Innsbruck, Austria. , Philipp EllerPhilipp Eller From the Department of Internal Medicine (I.T., P.E., R.K., J.R.P.) and Department of Neurology (M.S.), Innsbruck Medical University, Innsbruck, Austria. , Michael SpiegelMichael Spiegel From the Department of Internal Medicine (I.T., P.E., R.K., J.R.P.) and Department of Neurology (M.S.), Innsbruck Medical University, Innsbruck, Austria. , Rudolf KirchmairRudolf Kirchmair From the Department of Internal Medicine (I.T., P.E., R.K., J.R.P.) and Department of Neurology (M.S.), Innsbruck Medical University, Innsbruck, Austria. and Josef R. PatschJosef R. Patsch From the Department of Internal Medicine (I.T., P.E., R.K., J.R.P.) and Department of Neurology (M.S.), Innsbruck Medical University, Innsbruck, Austria. Originally published1 Apr 2008https://doi.org/10.1161/CIRCULATIONAHA.107.733097Circulation. 2008;117:e299A 54-year–old white woman presented at the emergency department because of progressive tetraparesis, which had developed over the past few days. She was alert but unable to walk or to hold a cup of coffee. Neurological evaluation revealed flaccid paresis of all limbs, sonography showed acute urinary retention of 800 mL, and cranial computed tomography was normal. The ECG showed a prominent U-wave (the Figure), and laboratory examinations revealed a massive hypokalemia of 1.13 mmol/L. The transtubular potassium gradient was >4, and blood pH was 7.47. The patient was immediately admitted to the intensive care unit, and potassium was intravenously administered at a rate of 15 mmol/h. Electrocardiographic abnormalities as well as paralysis resolved in reverse order of appearance over the next several hours. The patient had no premedication. She had just stopped smoking and had therefore ingested excessive amounts of licorice (approximately 750 g/d) during the previous 2 weeks. Licorice contains the steroid-like glycoside glycyrrhizinic acid. Glycyrrhizinic acid can induce pseudohyperaldosteronism by inhibition of the 11β-hydroxysteroid dehydrogenase, which normally converts cortisol to cortisone in the distal nephron1 and inhibits glucocorticoid-stimulated kaliuresis. An overdose of licorice can thus lead to an apparent mineralocorticoid excess and should be considered in the differential diagnosis of hypokalemic paresis and harmful cardiac arrhythmias.2,3Download figureDownload PowerPointFigure. Twelve-lead ECG shows prominent U-waves due to hypokalemia of 1.13 mmol/L.DisclosuresNone.FootnotesCorrespondence to Ivan Tancevski, Department of Internal Medicine, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria. E-mail [email protected]References1 Edwards CR, Stewart PM, Burt D, Brett L, McIntyre MA, Sutanto WS, de Kloet ER, Monder C. Localisation of 11 β-hydroxysteroid dehydrogenase–tissue specific protector of the mineralocorticoid receptor. Lancet. 1988; 2: 986–989.CrossrefMedlineGoogle Scholar2 Bauchart JJ, Loubeyre C, Asseman P, Thery C. Alcohol-free pastis and hypokalaemia. Lancet. 1995; 346: 1701.Google Scholar3 Nielsen I, Pedersen RS. Life-threatening hypokalaemia caused by liquorice ingestion. Lancet. 1984; 1: 1305.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Brown A (2017) Heart Toxicity Related to Herbs and Dietary Supplements: Online Table of Case Reports. Part 4 of 5., Journal of Dietary Supplements, 10.1080/19390211.2017.1356418, 15:4, (516-555), Online publication date: 4-Jul-2018. Omar H, Komarova I, El-Ghonemi M, Fathy A, Rashad R, Abdelmalak H, Yerramadha M, Ali Y, Helal E and Camporesi E (2012) Licorice abuse: time to send a warning message, Therapeutic Advances in Endocrinology and Metabolism, 10.1177/2042018812454322, 3:4, (125-138), Online publication date: 1-Aug-2012. Wynn G, Davis G and Maher B (2011) Trick or Treat? Pseudohyperaldosteronism Due to Episodic Licorice Consumption, The Journal of Clinical Hypertension, 10.1111/j.1751-7176.2010.00413.x, 13:3, (E3-E4), Online publication date: 1-Mar-2011. April 1, 2008Vol 117, Issue 13 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.107.733097PMID: 18378620 Originally publishedApril 1, 2008 PDF download Advertisement SubjectsArrhythmiasElectrocardiology (ECG)