Lethal liquorice lollies (liquorice abuse causing pseudohyperaldosteronism)

Abstract

A 47-year-old woman was admitted to the emergency department with a history of asthenia, periorbital and lower limbs oedema, associated with hypokalaemia and increased blood pressure levels. Metabolic and renal causes were initially investigated as thyroid disease, Cushing syndrome and tubulopathies were excluded during the first week of admission. However, further questioning of the patient, revealed that she had been consuming several sachets of raw liquorice lollies (ignored amount) obtained from a herbalist a month ago. Based on the history and clinical findings, liquorice poisoning was highly suspected; an apparent mineralocorticoid excess secondary to ingestion of liquorice. Afterwards, levels of aldosterone and plasma renin activity were measured and found low 3 weeks later; therefore, our clinical suspicion was established. During the patient's stay at the hospital, liquorice was stopped and potassium supplements were started. Subsequently, a week after, the patient fully recovered without any significant sequelae.

Hypertension induced by liquorice tea

“…In the UK, the Food Standards Agency currently requires that any beverage containing more than 50 mg/L of glycyrrhizin carry a warning that states “contains liquorice—people suffering from hypertension should avoid excessive consumption.”9 However, as is evident from this case and other reports involving confectionary,10 11 liquorice can also induce hypertension in normotensive subjects, and the definition of excessive consumption is not clear. This may lead to a false sense of security among healthy individuals such as our patient, who may not consider themselves to be at risk of developing hypertension.…”

Research Progress on the Antiviral Activity of Glycyrrhizin and its Derivatives in Liquorice

“…Although liquorice is believed to be a healthy natural herb without any serious adverse effects ( Kwon et al, 2020 ), it should be used with caution, particularly in patients with hypertension, considering its side effects. Side effects reported in literature include hypokalaemia ( Sontia et al, 2008 ; Flores-Robles et al, 2013 ), hypertension ( Smedegaard and Svart, 2019 ), hypertensive encephalopathy ( Russo et al, 2000 ), rhabdomyolysis ( Alaygut et al, 2017 ), and cardiac arrest ( Attou et al, 2020 ). A good correlation has been observed between the content of glycyrrhizin and the incidence of side effects, which indicates that the content of glycyrrhizin is a suitable index to avoid adverse reactions ( Nose et al, 2017 ).…”

The Pharmacological Effects of Benachio-F®on Rat Gastrointestinal Functions

“…The most prominent effects were reported for Corydalis Tuber (alkaloid: bulbocapnine) and Glycyrrhizae Radix (triterpenoid saponin: glycyrrhizine). Bulbocapnine has been reported to induce dose dependent catalepsis and convulsions, while glycyrrhizine has been associated with hypertension, hypokalemia, hypernatremia and some very rare cases of pseudoaldosteronism ( Loizzo et al ., 1971 ; Robles et al ., 2103 ). The most commonly reported side-effect was allergic reaction in sensitive patients.…”