Severe Hypokalaemia Secondary to Overindulgence in Alcohol-Free "Pastis"

Haberer, J.-P.; Jouve, Philippe; Bedock, B.; Bazin, Patrick

doi:10.1016/s0140-6736(84)90984-x

Cited by 8 publications

(4 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypokalaemic hypertension with a low plasma renin activity level is not pathognomonic for liquorice‐induced hypertension, because it can also be found in several other conditions such as primary aldosteronism, Liddle’s syndrome and deoxycorticosterone‐excess states, like 11β‐hydroxylase and 17α‐hydroxylase deficiency, adrenal carcinoma and Cushing’s syndrome. Furthermore, glycyrrhizin is not only a compound of liquorice, but is frequently added as a sweetener to many food products including beverages, chewing gum, smokeless tobacco and certain medications [2, 6, 16–18]. Due to this widespread use, a patient can be completely unaware of consuming any glycyrrhizin‐containing product.…”

Section: Introductionmentioning

confidence: 99%

Gas chromatographic–mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse

Kerstens

Guillaume²,

Wolthers³

et al. 1999

Journal of Internal Medicine

View full text Add to dashboard Cite

Abstract. Kerstens MN, Guillaume CPF, Wolthers BG, Dullaart RPF (University Hospital Groningen, Groningen, The Netherlands). Gas chromatographic±mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse. J Intern Med 1999; 246: 539±547.Objectives. Liquorice abuse can lead to severe clinical complications, caused by its active compound 18b-glycyrrhetinic acid (18bGA). 18bGA inhibits dehydrogenase activity of 11b-hydroxysteroid dehydrogenase (11bHSD). This enzyme catalyses the interconversion between cortisol and cortisone and normally protects the mineralocorticoid receptor from being activated by cortisol. Diagnosing liquorice abuse can be notoriously difficult. The aim of our study was to develop an accurate and clinically applicable 18bGA urinary assay. Design. We developed a urinary 18bGA assay based on gas chromatography and mass spectrometry (GCMS) with sufficient sensitivity to detect 18bGA at low concentrations. The assay was validated in four volunteers consuming different amounts of liquorice. We applied its use in two patients with hypokalaemic hypertension and suppressed plasma renin activity and serum aldosterone, who were suspected of liquorice abuse. Results. The detection limit for 18bGA of the GC assay was 10 mg L 21 , which was lowered to 3 mg L 21 by subsequent application of MS. In all volunteers, urinary 18bGA was detected during liquorice intake. Urinary 18bGA remained detectable until 5 days after stopping continued liquorice intake and until at least 51 h after ingestion of a single large amount. Urinary 18bGA was demonstrated in both patients, establishing a diagnosis of liquorice abuse. One patient showed changes in urinary cortisol metabolites, consistent with 11bHSD inhibition. Changes in cortisol metabolites were less pronounced in the other patient. Conclusion. Liquorice abuse can result in hypokalaemic hypertension with prolonged suppression of plasma renin activity and aldosterone concentration. This is caused by 18bGA-mediated inhibition of 11bHSD, resulting in activation of the renal mineralocorticoid receptor by cortisol. Urinary 18bGA measurement by GCMS is a useful aid in establishing liquorice abuse.

show abstract

Section: Introductionmentioning

confidence: 99%

Gas chromatographic–mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse

Kerstens

Guillaume²,

Wolthers³

et al. 1999

Journal of Internal Medicine

View full text Add to dashboard Cite

show abstract

“…In Northern Europe, natural liquorice is used as a flavouring in confectionary, while in North America most liquorice confectionary contains artificial flavouring. Liquorice is used as an additive in chewing tobacco, 9 alcohol-free drinks, 10 chewing gum 11 and is commonly used as a laxative 12 and an antacid. 13 The association between chronic liquorice ingestion and oedema was first described in 1950.…”

Section: Liquorice Toxicitymentioning

confidence: 99%

Hypokalaemia: The Dangers of a Sweet Tooth

Taylor

Chambers

Patel

et al. 2012

Journal of the Intensive Care Society

View full text Add to dashboard Cite

Liquorice is well known to inhibit the renal tubular enzyme 11-β-hydroxysteroid dehydrogenase, causing a syndrome of apparent mineralocorticoid excess. This is a rare condition, usually resulting from chronic ingestion of liquorice-containing products. The case report relates to an 84-year-old woman with chronic hypertension who developed profound weakness following a liquorice ‘binge’ which, to our knowledge, is only the second reported case of profound metabolic disturbance as a result of acute liquorice ingestion. The differential diagnosis of hypokalaemia and the importance of the clinical history are discussed, with a review of medication and analysis of the acid-base status.

show abstract

“…Glycyrrhetic acid mainly inhibits type-2 11β-HSD in mineralocorticoid tissues and increases the cortisol concentrations resulting in retention of sodium and water, a syndrome of apparent mineralocorticoid excess. Based on information from effects in humans, JECFA concluded that an intake of 100 mg/day would be unlikely to cause adverse effects in the majority of adults (FAO/WHO, 2006b;Stoermer et al, 1993;Schambelan, 1994;Kerlan et al, 1994;Haberer et al, 1984).…”

Section: Saponins In Other Plantsmentioning

confidence: 99%

Saponins in Madhuca Longifolia as undesirable substances in animal feed

2009

EFSA Journal

View full text Add to dashboard Cite

SUMMARYSaponins are a diverse group of low molecular-weight secondary plant metabolites that are widely distributed in the plant kingdom. The chemical structure of saponins consists of an aglycone of either steroidal or a triterpenoid nature and one or more sugar chains (glycosides). Saponins can form stable foam in aqueous solutions, hence the name "saponin" from the Latin word for soap (sapo). Traditionally, they have been used as detergents, piscicides and molluscicides in addition to industrial applications as foaming and surface active agents.Madhuca longifolia and other Madhuca species are large evergreen or semi-evergreen trees with a dense spreading crown extensively cultivated in warm climates for their oil-containing seeds. The present opinion deals with saponins in Madhuca longifolia and other Madhuca species as potentially undesirable compounds in feed. Possible occurrence of saponins and also cyanogenic glycosides in "unhusked beech mast" from Fagus silvatica with regard to its listing as an undesirable substance in animal feed was also included in the request. However, since it does not contain saponins or cyanogenic glycosides in significant amounts and its reported toxicity in cattle and horses can most likely be attributed to its high content of oxalates, beech mast is not further discussed in this opinion. Saponins in Madhuca longifolia L. as undesirable substances in animal feedThe EFSA Journal (2009) Results from studies on Madhuca seed cakes, which contain saponins, on ruminants indicate that they are more tolerant to Madhuca saponins than monogastric animals and can tolerate inclusion levels of up to a maximum of 20% of the total diet. Toxicity studies of Madhuca seeds on monogastric target animals are scarce. Madhuca seed cake in chick mash at approximately 12% level was lethal. No studies have been conducted on horses, pigs, rabbits or dogs. Except for piscicidal effect of Madhuca saponins by water exposure in guppy fish, no toxicity studies after dietary exposure were identified in fish.Data on occurrence of Madhuca as a botanical impurity in feed are not available. Because of its limited value as feed for livestock Madhuca is not imported into the EU either as whole seeds or as meal. In producing countries, Madhuca cake is used mainly as a fertiliser and to a limited extent as feed because of its protein content. Data for the carry-over and residues of Madhuca saponins are not available. Madhuca products are not consumed by humans as part of the diet and human dietary exposure to Madhuca saponin through the consumption of animal products is very unlikely as the only potential source would be imported food of animal origin from animals fed Madhuca. The CONTAM Panel concludes that human dietary exposure to Madhuca saponins in the EU can be considered as negligible.

show abstract

Severe Hypokalaemia Secondary to Overindulgence in Alcohol-Free "Pastis"

Cited by 8 publications

References 9 publications

Gas chromatographic–mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse

Gas chromatographic–mass spectrometric analysis of urinary glycyrrhetinic acid: an aid in diagnosing liquorice abuse

Hypokalaemia: The Dangers of a Sweet Tooth

Saponins in Madhuca Longifolia as undesirable substances in animal feed

Contact Info

Product

Resources

About