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. 1980 Jul;56(657):526–529. doi: 10.1136/pgmj.56.657.526

Severe hypokalaemia with paralysis induced by small doses of liquorice.

A M Cumming, K Boddy, J J Brown, R Fraser, A F Lever, P L Padfield, J I Robertson
PMCID: PMC2425815  PMID: 7443613

Abstract

A patient, who presented with a flaccid quadriplegia due to profound hypokalaemia, is described. Hypokalaemia and myoglobinuria were caused by the ingestion of small amounts of liquorice contained in a laxative preparation. Subsequent controlled administration of small amounts of this preparation induced marked hypokalaemia. This was associated with sodium retention and potassium loss confirming a mineralocorticoid-like action. The sodium retention was associated with suppression of plasma levels of renin and aldosterone.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bannister B., Ginsburg R., Shneerson J. Cardiac arrest due to liquoriceinduced hypokalaemia. Br Med J. 1977 Sep 17;2(6089):738–739. doi: 10.1136/bmj.2.6089.738-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Brown J. J., Davies D. L., Lever A. F., Robertson J. I., Tree M. The estimation of renin in human plasma. Biochem J. 1964 Dec;93(3):594–600. doi: 10.1042/bj0930594. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Conn J. W., Rovner D. R., Cohen E. L. Licorice-induced pseudoaldosteronism. Hypertension, hypokalemia, aldosteronopenia, and suppressed plasma renin activity. JAMA. 1968 Aug 12;205(7):492–496. doi: 10.1001/jama.205.7.492. [DOI] [PubMed] [Google Scholar]
  4. Davies D. L., Robertson J. W. Simultaneous measurement of total exchangeable potassium and sodium using 43 K and 24 Na. Metabolism. 1973 Feb;22(2):133–137. doi: 10.1016/0026-0495(73)90263-1. [DOI] [PubMed] [Google Scholar]
  5. Edelman I. S., Olney J. M., James A. H., Brooks L., Moore F. D. Body Composition: Studies in the Human Being by the Dilution Principle. Science. 1952 Apr 25;115(2991):447–454. doi: 10.1126/science.115.2991.447. [DOI] [PubMed] [Google Scholar]
  6. Epstein M. T., Espiner E. A., Donald R. A., Hughes H. Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects. Br Med J. 1977 Feb 19;1(6059):488–490. doi: 10.1136/bmj.1.6059.488. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Epstein M. T., Espiner E. A., Donald R. A., Hughes H. Liquorice toxicity and the renin-angiotensin-aldosterone axis in man. Br Med J. 1977 Jan 22;1(6055):209–210. doi: 10.1136/bmj.1.6055.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. FORBES G. B., PERLEY A. Estimation of total body sodium by isotopic dilution. II. Studies on infants and children: an example of a constant differential growth ratio. J Clin Invest. 1951 Jun;30(6):566–574. doi: 10.1172/JCI102473. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Forshaw J. Muscle paresis and hypokalemia after treatment with duogastrone. Br Med J. 1969 Jun 14;2(5658):674–674. doi: 10.1136/bmj.2.5658.674. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Fraser R., Guest S., Young J. A comparison of double-isotope derivative and radioimmunological estimation of plasma aldosterone concentration in man. Clin Sci Mol Med. 1973 Sep;45(3):411–415. doi: 10.1042/cs0450411. [DOI] [PubMed] [Google Scholar]
  11. Gross E. G., Dexter J. D., Roth R. G. Hypokalemic myopathy with myoglobinuria associated with licorice ingestion. N Engl J Med. 1966 Mar 17;274(11):602–606. doi: 10.1056/NEJM196603172741104. [DOI] [PubMed] [Google Scholar]
  12. Holmes A. M., Young J., Marrott P. K., Prentice E. Pseudohyperaldosteronism induced by habitual ingestion of liquorice. Postgrad Med J. 1970 Oct;46(540):625–629. [PMC free article] [PubMed] [Google Scholar]
  13. LOUIS L. H., CONN J. W. Preparation of glycyrrhizinic acid, the electrolyte-active principle of licorice: its effects upon metabolism and upon pituitary-adrenal function in man. J Lab Clin Med. 1956 Jan;47(1):20–28. [PubMed] [Google Scholar]
  14. MILLER H., WILSON G. M. The measurement of exchangeable sodium in man using the isotope 24Na. Clin Sci. 1953 May;12(2):97–111. [PubMed] [Google Scholar]
  15. MOLHUYSEN J. A., GERBRANDY J., de VRIES L. A., de JONG J. C., LENSTRA J. B., TURNER K. P., BORST J. G. G. A liquorice extract with deoxycortone-like action. Lancet. 1950 Sep 23;2(6630):381–386. doi: 10.1016/s0140-6736(50)91341-9. [DOI] [PubMed] [Google Scholar]
  16. Mohamed S. D., Chapman R. S., Crooks J. Hypokalaemia, flaccid quadruparesis, and myoglobinuria with carbenoxolone (biogastrone). Br Med J. 1966 Jun 25;1(5503):1581–1582. doi: 10.1136/bmj.1.5503.1581. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. SALASSA R. M., MATTOX V. R., ROSEVEAR J. W. Inhibition of the "mineralocorticoid" activity of licorice by spironolactone. J Clin Endocrinol Metab. 1962 Nov;22:1156–1159. doi: 10.1210/jcem-22-11-1156. [DOI] [PubMed] [Google Scholar]

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