A Case of Liquorice-Infused Marijuana Causing Syndrome of Apparent Mineralocorticoid Excess

Marijuana has long been used both for recreational and medicinal purposes. Most of the available forms of marijuana contain additives such as liquorice to enhance its flavour. Liquorice increases the amounts of cortisol in the body and produces metabolic abnormalities seen in primary hyperaldosteronism([1]). Liquorice extracts are mixed with marijuana in the same way as for tobacco([2,3]). We describe a case of apparent mineralocorticoid excess due to excessive smoking of liquorice-laced marijuana. To our knowledge, this is the first reported case of apparent mineralocorticoid excess caused by marijuana use. LEARNING POINTS: First report of liquorice-laced marijuana causing syndrome of apparent mineralocorticoid excess (SAME). Since its legalisation, marijuana is reported to be the most used substance second only to alcohol. With the increased availability of marijuana, the health care providers and consumers must be cognisant of its side effects. It is a dose-dependent phenomenon. The effects vary from minor clinical symptoms to fatal arrhythmias based on the amount consumed.