Korean J Med.  2011 Jun;80(Suppl 2):S258-S262.

A Case of Licorice-Induced Hypokalemic Rhabdomyolysis in a Patient Using a Diuretic Drug

• Park KA
• Seok SJ
• Kim SJ
• Gil HW
• Yang JO
• Lee EY
• Hong SY

Abstract

Glycyrrhizic acid is a component of licorice. It can cause hypokalemia through the inhibition of 11beta-hydroxysteroid dehydrogenase. The severity of symptoms depends on the dose and duration of licorice intake, as well as the individual susceptibility. The safe dose of licorice is 10 mg per day. Even a small amount of licorice can cause side effects, including hypokalemia in patients taking diuretics, with diarrhea, or congestive heart failure. We experienced a 59-year-old male with muscle weakness. He had ingested losartan and indapamide due to hypertension. At presentation, he had ingested 8 mg of licorice daily for the previous 17 days. The patient presented with severe hypokalemia (1.8 mEq/L) and rhabdomyolysis. His renin activity was 0.44 ng/mL/h, and his aldosterone level was 6.0 pg/mL. After cessation of licorice and indapamide, his potassium level recovered. In conclusion, even a small amount of licorice can induce hypokalemia in patients who are taking diuretics.

Keyword

Glycyrrhizic acid; Hypokalemia; Rhabdomyolysis

MeSH Terms

11-beta-Hydroxysteroid Dehydrogenases
Aldosterone
Diarrhea
Diuretics
Glycyrrhiza
Glycyrrhizic Acid
Heart Failure
Humans
Hypertension
Hypokalemia
Indapamide
Losartan
Male
Middle Aged
Muscle Weakness
Potassium
Renin
Rhabdomyolysis
11-beta-Hydroxysteroid Dehydrogenases
Aldosterone
Diuretics
Glycyrrhizic Acid
Indapamide
Losartan
Potassium
Renin