Licorice Induced Hypokalemia

Abstract

A high intake of licorice can cause hypermineralocorticoidism with sodium retention and potassium loss, edema, increased blood pressure and depression of renin-angiotensin-aldosterone system. Glycyrrhizic acid, a component of licorice, produces hypermineralocorticoidism through the inhibition of 11β-hydroxy-steroid dehydrogenase. We report a 55-year-old woman with severe muscle weakness with hypokalemia(Serum K+:1.7 mEq/ℓ ) due to raw licorice tea. She boiled the licorice 50g in water and drunk intermittently for 4 months due to her foreign body sensation on her throat. In Korea there is a traditional recipe that licorice works out for the above symptom. Her serum renin activity and aldosterone level were far beyond normal range which was typical to licorice ingestion. She also had metabolic alkalosis with pH 7.55 and hypertension. After quitting the licorice, hypokalemia and muscle weakness gradually improved and her blood pressure returned to normal.