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

Korean J Med > Volume 80(2); 2011 > Article

Original Article

The Korean Journal of Medicine 2011;80(2):258-262.

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

Kyong Ah Park, Soo Jin Seok, Su Ji Kim, Hyo Wook Gil, Jong Oh Yang, Eun Young Lee, Sae Yong Hong

이뇨제 복용 중 소량의 감초 복용 후 발생한 저칼륨혈증성 횡문근 융해증 1예

박경아, 석수진, 김수지, 길효욱, 양종오, 이은영, 홍세용

Abstract

Glycyrrhizic acid is a component of licorice. It can cause hypokalemia through the inhibition of 11β-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.

Key Words: Glycyrrhizic acid; Hypokalemia; Rhabdomyolysis