1
|
Blanpain JS, Adler JR. A Licorice-Flavored Edema: A Case Report of Glycyrrhizic Acid Toxicity From Chronic Licorice Root Consumption. Cureus 2023; 15:e34425. [PMID: 36874748 PMCID: PMC9981224 DOI: 10.7759/cureus.34425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 02/01/2023] Open
Abstract
This article presents a case study of a 49-year-old patient who was admitted to the emergency department with hypertension, edema, and intense fatigue caused by excessive consumption for three weeks of licorice herbal teas purchased on the internet. The patient was only taking antiaging hormonal treatment. The examination revealed bilateral edema of the face and lower limbs, and blood tests showed discrete hypokalemia (3.1 mmol/L) and low aldosterone levels. The patient revealed that she had been consuming large amounts of licorice herbal teas to compensate for the lack of sweetness in her low-sugar diet. This case study highlights that although licorice is widely used for its sweet taste and has medicinal properties, it can also have a mineralocorticoid-like activity that can lead to apparent mineralocorticoid excess (AME) when consumed in excess. The main component of licorice responsible for these symptoms is glycyrrhizic acid, which increases the availability of cortisol by decreasing its catabolism and has a mineralocorticoid effect through the inhibition of the enzyme 11-β-hydroxysteroid dehydrogenase (11-β-HSD) type 2. The case also discusses the clinical effects of licorice consumption, such as sodium retention and potassium excretion, leading to potential cardiovascular complications, as well as a differential diagnosis of similar clinical presentations mainly based on laboratory findings including aldosterone level and plasma renin activity (PRA). The potential dangers of consuming excessive amounts of licorice are well established, and we advocate stricter regulations and increased awareness and education for both the general public and the medical profession about these negative side effects and suggest that physicians should consider licorice consumption in their approach to patients' lifestyles and diets.
Collapse
Affiliation(s)
- Jean-Samuel Blanpain
- Emergency Medicine, Centre Hospitalier Régional Sambre et Meuse (CHRSM), Namur, BEL
| | - John R Adler
- Emergency Medicine, Centre Hospitalier Régional Sambre et Meuse (CHRSM), Namur, BEL
| |
Collapse
|
2
|
Shibata T, Yoshinuma H, Sugiyama D, Kobayashi O. Severe Hypokalemia and Metabolic Alkalosis Caused by Licorice Discovered During the Treatment of Intraoperative Hypoxemia. Cureus 2022; 14:e25432. [PMID: 35774714 PMCID: PMC9236722 DOI: 10.7759/cureus.25432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 11/05/2022] Open
|
3
|
Fan ZJ, Liu JM, Li XX, Cui J, Guo B, Lin Q, Zhuang R, Wu ZB, Wu Y. Glycyrrhizin-Induced Pseudohyperaldosteronism: A Case Report. Chin J Integr Med 2022; 28:644-649. [PMID: 35015223 DOI: 10.1007/s11655-021-3312-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/03/2022]
Abstract
In conclusion, this case should remind clinicians of the potential dangers of glycyrrhizin (high blood pressure, low blood potassium and abnormal changes in ECG, among other effects). The timely detection and effective treatment of glycyrrhizin-induced PsHA can prevent the occurrence of serious complications. The importance of taking a detailed medical history is also emphasized.
Collapse
Affiliation(s)
- Zong-Jing Fan
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jin-Min Liu
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Xing-Xing Li
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Jie Cui
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Bin Guo
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Quan Lin
- Department of Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, 100091, China
| | - Rui Zhuang
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Zheng-Bo Wu
- Department of Graduate School, Beijing University of Chinese Medicine, Beijing, 100029, China
| | - Yang Wu
- Department of Cardiology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China.
| |
Collapse
|