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Hypokalemic paralysis and respiratory failure due to excessive intake of licorice syrup

Year 2014, Volume: 39 Issue: 2, 387 - 391, 22.07.2014
https://doi.org/10.17826/cutf.03944

Abstract

Licorice is the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypokalemia, hypertension, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this paper, an 34 years old man who admitted to the emergency department with respiratory failure and marked muscle weakness of all extremities that progressed to paralysis after excessive intake of licorice syrup was presented. It was aimed to draw attention to the necessity of questioning whether there is excessive intake of licorice or not in patients who admitted to emergency department with paralysis and dyspnea. Plasma potassium concentration of the patient was 1.4 mmol/L. The patient's respiratory distress and loss of muscle strength recovered completely after potassium replacement.

References

  • Zengin S, Oktay MM, Al B, Yılmaz DA, Boğan M, Safi1 Y et al. Dönemsel bir akciğer ödemi nedeni: meyan şerbeti içimi. Gaziantep Tıp Derg. 2013;19:99
  • Omar HR, Komarova I, El-Ghonemi M, Fathy A, Rashad R, Abdelmalak HD et al. Licorice abuse: time to send a warning message. Ther Adv Endocrinol Metab. 2012;3:125-38.
  • Fiore C, Eisenhut M, Ragazzi E, Zanchin G, Armanini D. A history of the therapeutic use of liquorice in Europe. Journal of Ethnopharmacology. 2005;99:317–24.
  • Li W, Asda Y, Yoshikawas T. Antimicrobial flavonoids from Glycyrrhiza glabra hairy root cultures. Planta Medica. 1998;64:746–7.
  • Finney RSH, Sommers GF. Anti-inflammtory activity of glycyrrhetinic acid and derivatives. Journal of Pharmacy and Pharmacology. 1958;10:613.
  • Ikram M, Zirvi KA. Chemistry and pharmacology of liquorice (genus Glycyrrhiza). Herba Polonica. 1976;22:312–20.
  • Mezenova TD. Hypolipidemic activity of licorice root extract. Pharmaceutical Chemistry Journal (USSR). 1984;17:275–7.
  • Al-Qarawi AA, Abdel-Rahman HA, El-Mougy SA. Hepatoprotective activity of licorice in rat liver injury models. Journal of Herbs, Spices and Medicinal Plants. 2001;8:7–14.
  • Khayyal MT, El-Ghazaly MT, Kenawy SA, Seif-Al Naser M, Mahran LG, Kafafi YA et al. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001;51:545–53.
  • Imtiaz KE. Sweet root, bitter pill: liquorice-induced hyperaldosteronism. QJM. 2011;104:1093–5.
  • Farese RV, Biglieri EG, Shakelton CH, Irony I, Gomez-Fontes R. Licorice-induced hypermineralocorticoidism. N Engl J Med. 1991;325:1223-7.
  • Hamidon BB, Jeyabalan V. Exogenously-induced apparent hypermineralocorticoidism associated with ingestion of “asam boi”. Singapore Med J. 2006;47:156-8.
  • Meltem AC, Figen C, Nalan MA, Mahir K, Sebnem B, Mehlika I et al. A hypokalemic muscular weakness after licorice ingestion: a case report. Cases J. 2009;2:8053.
  • Yasue H, Itoh T, Mizuno Y, Harada E. Severe hypokalemia, rhabdomyolysis, muscle paralysis, and respiratory impairment in a hypertensive patient taking herbal medicines containing licorice. Intern Med. 2007;46:575-8.
  • Van den Bosch AE, Van der Klooster JM, Zuidgeest DM, Ouwendijk RJ, Dees A. Severe hypokalaemic paralysis and rhabdomyolysis due to ingestion of licorice. Neth J Med. 2005;63:146–8.
  • Lin SH, Yang SS, Chau T, Halperin ML. An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci. 2003;325:153-6.
  • Elinav E, Chajek-Shaul T. Licorice consumption causing severe hypokalemic paralysis. Mayo Clin Proc. 2003;78:767–8.
  • Russo S, Mastropasqua M, Mosetti MA, Persegani C, Paggi A. Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol. 2000;20:145–8.
  • Londner M, Hammer D, Kelen GD. Fluid and electrolyte problems. In Emergency Medicine: A Comprehensive Study Guide, 7th ed (Eds Tintinalli JE, Kelen GD, Stapczynski JS): New York, McGrawHill, 2004;167-79.
  • Yazışma Adresi / Address for Correspondence: Dr. Mehmet Oğuzhan Ay Adana Numune Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Ege Bagatur Bulvarı üzeri, 01240, Yureğir, Adana, Türkiye
  • Email: droguzhan2006@mynet.com geliş tarihi/received :28.09.2013 kabul tarihi/accepted:31.10.2013

Aşırı meyan kökü şerbeti alımına bağlı hipopotasemik paralizi ve solunum yetersizliği

Year 2014, Volume: 39 Issue: 2, 387 - 391, 22.07.2014
https://doi.org/10.17826/cutf.03944

Abstract

Meyan kökü glycyrrhizic acid içeren Glycyrrhiza glabra"nın köküdür. Aşırı meyan kökü alımı sodyum ve su retansiyonu, hipokalemi, hipertansiyon, metabolik alkaloz, düşük renin aktivitesi ve hipoaldosteronizm ile karekterize hipermineralokortikoidizm benzeri sendroma yol açabilir. Bu yazıda aşırı meyan kökü şerbeti içimi sonrası acil servise solunum sıkıntısı, kol ve bacaklarında güçsüzlük nedeniyle getirilen hipopotasemik paralizili 34 yaşındaki erkek hasta sunuldu. Acil Servise paralizi ve solunum sıkıntısıyla gelen hastalarda aşırı meyan kökü alımı olup olmadığının sorgulanması gerekliliğine dikkat çekilmesi amaçlandı. Kan potasyum düzeyi 1.4 mmol/L olan hastanın potasyum replasmanı sonrası solunum sıkıntısı ve kas kuvvet kaybı tamamen düzeldi.

References

  • Zengin S, Oktay MM, Al B, Yılmaz DA, Boğan M, Safi1 Y et al. Dönemsel bir akciğer ödemi nedeni: meyan şerbeti içimi. Gaziantep Tıp Derg. 2013;19:99
  • Omar HR, Komarova I, El-Ghonemi M, Fathy A, Rashad R, Abdelmalak HD et al. Licorice abuse: time to send a warning message. Ther Adv Endocrinol Metab. 2012;3:125-38.
  • Fiore C, Eisenhut M, Ragazzi E, Zanchin G, Armanini D. A history of the therapeutic use of liquorice in Europe. Journal of Ethnopharmacology. 2005;99:317–24.
  • Li W, Asda Y, Yoshikawas T. Antimicrobial flavonoids from Glycyrrhiza glabra hairy root cultures. Planta Medica. 1998;64:746–7.
  • Finney RSH, Sommers GF. Anti-inflammtory activity of glycyrrhetinic acid and derivatives. Journal of Pharmacy and Pharmacology. 1958;10:613.
  • Ikram M, Zirvi KA. Chemistry and pharmacology of liquorice (genus Glycyrrhiza). Herba Polonica. 1976;22:312–20.
  • Mezenova TD. Hypolipidemic activity of licorice root extract. Pharmaceutical Chemistry Journal (USSR). 1984;17:275–7.
  • Al-Qarawi AA, Abdel-Rahman HA, El-Mougy SA. Hepatoprotective activity of licorice in rat liver injury models. Journal of Herbs, Spices and Medicinal Plants. 2001;8:7–14.
  • Khayyal MT, El-Ghazaly MT, Kenawy SA, Seif-Al Naser M, Mahran LG, Kafafi YA et al. Antiulcerogenic effect of some gastrointestinally acting plant extracts and their combination. Arzneimittelforschung. 2001;51:545–53.
  • Imtiaz KE. Sweet root, bitter pill: liquorice-induced hyperaldosteronism. QJM. 2011;104:1093–5.
  • Farese RV, Biglieri EG, Shakelton CH, Irony I, Gomez-Fontes R. Licorice-induced hypermineralocorticoidism. N Engl J Med. 1991;325:1223-7.
  • Hamidon BB, Jeyabalan V. Exogenously-induced apparent hypermineralocorticoidism associated with ingestion of “asam boi”. Singapore Med J. 2006;47:156-8.
  • Meltem AC, Figen C, Nalan MA, Mahir K, Sebnem B, Mehlika I et al. A hypokalemic muscular weakness after licorice ingestion: a case report. Cases J. 2009;2:8053.
  • Yasue H, Itoh T, Mizuno Y, Harada E. Severe hypokalemia, rhabdomyolysis, muscle paralysis, and respiratory impairment in a hypertensive patient taking herbal medicines containing licorice. Intern Med. 2007;46:575-8.
  • Van den Bosch AE, Van der Klooster JM, Zuidgeest DM, Ouwendijk RJ, Dees A. Severe hypokalaemic paralysis and rhabdomyolysis due to ingestion of licorice. Neth J Med. 2005;63:146–8.
  • Lin SH, Yang SS, Chau T, Halperin ML. An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci. 2003;325:153-6.
  • Elinav E, Chajek-Shaul T. Licorice consumption causing severe hypokalemic paralysis. Mayo Clin Proc. 2003;78:767–8.
  • Russo S, Mastropasqua M, Mosetti MA, Persegani C, Paggi A. Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol. 2000;20:145–8.
  • Londner M, Hammer D, Kelen GD. Fluid and electrolyte problems. In Emergency Medicine: A Comprehensive Study Guide, 7th ed (Eds Tintinalli JE, Kelen GD, Stapczynski JS): New York, McGrawHill, 2004;167-79.
  • Yazışma Adresi / Address for Correspondence: Dr. Mehmet Oğuzhan Ay Adana Numune Eğitim ve Araştırma Hastanesi, Acil Tıp Kliniği, Ege Bagatur Bulvarı üzeri, 01240, Yureğir, Adana, Türkiye
  • Email: droguzhan2006@mynet.com geliş tarihi/received :28.09.2013 kabul tarihi/accepted:31.10.2013
There are 21 citations in total.

Details

Primary Language Turkish
Journal Section Research
Authors

Mehmet Oğuzhan Ay This is me

Abdulkadir Aktürk This is me

Ahmet Çolakoğlu This is me

Alper Çelikdemir This is me

Nalan Kozacı This is me

Ayça Açıkalın This is me

Akkan Avci This is me

Salim Satar This is me

Publication Date July 22, 2014
Published in Issue Year 2014 Volume: 39 Issue: 2

Cite

MLA Ay, Mehmet Oğuzhan et al. “Aşırı Meyan kökü şerbeti alımına bağlı Hipopotasemik Paralizi Ve Solunum yetersizliği”. Cukurova Medical Journal, vol. 39, no. 2, 2014, pp. 387-91, doi:10.17826/cutf.03944.