Low-dose liquorice ingestion resulting in severe hypokalaemic paraparesis, rhabdomyolysis and nephrogenic diabetes insipidus

Putter, Robin De; Donck, J

doi:10.1093/ckj/sft159

Cited by 10 publications

(5 citation statements)

References 15 publications

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“…Although glycyrrhizic is widely recognized, it still has some limitations. Some researchers observed that glycyrrhizin maybe has side effects, including asthenia and muscle cramps (De Putter and Donck, 2014). A brief illustration of the different terpenoid phytochemicals is presented in Figure 3.…”

Section: Terpenoidsmentioning

confidence: 99%

Natural Anti-Inflammatory Compounds as Drug Candidates for Inflammatory Bowel Disease

et al. 2021

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Inflammatory bowel disease (IBD) represents chronic recurrent intestinal inflammation resulting from various factors. Crohn’s disease (CD) and ulcerative colitis (UC) have been identified as the two major types of IBD. Currently, most of the drugs for IBD used commonly in the clinic have adverse reactions, and only a few drugs present long-lasting treatment effects. Moreover, issues of drug resistance and disease recurrence are frequent and difficult to resolve. Together, these issues cause difficulties in treating patients with IBD. Therefore, the development of novel therapeutic agents for the prevention and treatment of IBD is of significance. In this context, research on natural compounds exhibiting anti-inflammatory activity could be a novel approach to developing effective therapeutic strategies for IBD. Phytochemicals such as astragalus polysaccharide (APS), quercetin, limonin, ginsenoside Rd, luteolin, kaempferol, and icariin are reported to be effective in IBD treatment. In brief, natural compounds with anti-inflammatory activities are considered important candidate drugs for IBD treatment. The present review discusses the potential of certain natural compounds and their synthetic derivatives in the prevention and treatment of IBD.

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Section: Terpenoidsmentioning

confidence: 99%

Natural Anti-Inflammatory Compounds as Drug Candidates for Inflammatory Bowel Disease

et al. 2021

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“…Liquorice is the root of Glycyrrhiza glabra and is mostly recognized as a flavoring agent. It has also been used in herbal medicine and even in anti-inflammatory, antiviral, antimicrobial, antioxidative, hepatoprotective, and cardioprotective properties[5]. Glycyrrhizic acid or its hydrolytic product, glycyrrhetinic acid, is found in liquorice extracts and has a well-known mineralcorticoid activity, inhibiting 11 beta-hydroxysteroid dehydrogenase type 2, the enzyme that converts cortisol to cortisone[4].…”

Section: Discussionmentioning

confidence: 99%

Liquorice-induced severe hypokalemic rhabdomyolysis with Gitelman syndrome and diabetes: A case report

Yang¹,

Yin²,

Yang³

et al. 2019

WJCC

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BACKGROUND Licorice-induced severe hypokalemic rhabdomyolysis is clinically rare. Gitelman syndrome (GS) is the most common inherited renal tubular disease, while diabetes is one of the most prevalent diseases in the world. Recently, some studies have found that GS patients had higher diabetic morbidity. However, the coexistence of these three diseases has yet to be reported. CASE SUMMARY We report the case of a 62-year-old Chinese man who was admitted with weakness in the extremities, muscle pain, and dark-colored urine. He had consumed liquorice water daily for seven days prior to admission. The laboratory tests revealed a serum potassium level of 1.84 mmol/L, magnesium 0.68 mmol/L, creatinine phosphokinase (CK) 10117 IU/L, and marked hemoglobinuria. Fractional chloride excretion and fractional magnesium excretion were increased. Plasma renin activity and aldosterone concentration were within the normal ranges. Sequence analysis of the SLC12A3 gene revealed that he had compound heterozygous mutations. The diagnosis of liquorice-induced severe hypokalemic rhabdomyolysis with GS and diabetes was thus genetically confirmed. Serum potassium and CK quickly improved with potassium replacement therapy, hydration, and discontinuation of liquorice ingestion. Upon follow-up at 3 mo, the levels of CK, myoglobin, and potassium remained normal, and magnesium was above 0.6 mmol/L. CONCLUSION This case emphasizes that liquorice consumption and GS should be considered causes of hypokalemia and that the diabetic status of GS patients should be noted in the clinic.

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“…The Scientific Committee on Food declared a GL consumption of 100 mg/day to be safe, based on studies involving human volunteers [6]. However, even lower doses may provoke critical manifestations according to different individual susceptibility to GA, as is widely reported in the literature [1,4,26,63,128,[130][131][132]. Apart from one paper by Sigurjònsdòttir et al [130], most studies showed no clear correlation between GA levels and severity of manifestations, such as, for example, degree of AH.…”

Section: Daily Dosagementioning

confidence: 99%

Liquorice Toxicity: A Comprehensive Narrative Review

Ceccuzzi,

Rapino,

Perna

et al. 2023

Nutrients

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Background: Renowned since ancient times for its medical properties, liquorice is nowadays mainly used for flavoring candies or soft drinks. Continuous intake of large amounts of liquorice is a widely known cause of pseudo-hyperaldosteronism leading to hypertension and hypokalemia. These manifestations are usually mild, although in some cases may generate life-threatening complications, i.e., arrhythmias, muscle paralysis, rhabdomyolysis, and coma. In addition, liquorice has an important estrogenic-like activity. Methods: We summarized the current knowledge about liquorice and reviewed 104 case reports in both the English and Italian languages from inception to June 2023 concerning complications due to an excess of liquorice intake. Results: In contrast to most published data, female sex and old age do not appear to be risk factors. However, hypertension and electrolyte imbalance (mainly hypokalemia) are prevalent features. The detection of glycyrrhetinic acid in blood is very uncommon, and the diagnosis is essentially based on an accurate history taking. Conclusions: Although there is not a significant mortality rate, liquorice toxicity often requires hospitalization and therefore represents a significant health concern. Major pharmaceutical drug regulatory authorities should solicit public awareness about the potentially dangerous effects caused by excessive use of liquorice.

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Low-dose liquorice ingestion resulting in severe hypokalaemic paraparesis, rhabdomyolysis and nephrogenic diabetes insipidus

Cited by 10 publications

References 15 publications

Natural Anti-Inflammatory Compounds as Drug Candidates for Inflammatory Bowel Disease

Natural Anti-Inflammatory Compounds as Drug Candidates for Inflammatory Bowel Disease

Liquorice-induced severe hypokalemic rhabdomyolysis with Gitelman syndrome and diabetes: A case report

Liquorice Toxicity: A Comprehensive Narrative Review

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