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Liquorice Toxicity: A Comprehensive Narrative Review

Background: Renowned since ancient times for its medical properties, liquorice is nowadays mainly used for flavoring candies or soft drinks. Continuous intake of large amounts of liquorice is a widely known cause of pseudo-hyperaldosteronism leading to hypertension and hypokalemia. These manifestati...

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Autores principales: Ceccuzzi, Giovanna, Rapino, Alessandro, Perna, Benedetta, Costanzini, Anna, Farinelli, Andrea, Fiorica, Ilaria, Marziani, Beatrice, Cianci, Antonella, Rossin, Federica, Cesaro, Alice Eleonora, Spampinato, Michele Domenico, De Giorgio, Roberto, Guarino, Matteo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10537237/
https://www.ncbi.nlm.nih.gov/pubmed/37764649
http://dx.doi.org/10.3390/nu15183866
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author Ceccuzzi, Giovanna
Rapino, Alessandro
Perna, Benedetta
Costanzini, Anna
Farinelli, Andrea
Fiorica, Ilaria
Marziani, Beatrice
Cianci, Antonella
Rossin, Federica
Cesaro, Alice Eleonora
Spampinato, Michele Domenico
De Giorgio, Roberto
Guarino, Matteo
author_facet Ceccuzzi, Giovanna
Rapino, Alessandro
Perna, Benedetta
Costanzini, Anna
Farinelli, Andrea
Fiorica, Ilaria
Marziani, Beatrice
Cianci, Antonella
Rossin, Federica
Cesaro, Alice Eleonora
Spampinato, Michele Domenico
De Giorgio, Roberto
Guarino, Matteo
author_sort Ceccuzzi, Giovanna
collection PubMed
description Background: Renowned since ancient times for its medical properties, liquorice is nowadays mainly used for flavoring candies or soft drinks. Continuous intake of large amounts of liquorice is a widely known cause of pseudo-hyperaldosteronism leading to hypertension and hypokalemia. These manifestations are usually mild, although in some cases may generate life-threatening complications, i.e., arrhythmias, muscle paralysis, rhabdomyolysis, and coma. In addition, liquorice has an important estrogenic-like activity. Methods: We summarized the current knowledge about liquorice and reviewed 104 case reports in both the English and Italian languages from inception to June 2023 concerning complications due to an excess of liquorice intake. Results: In contrast to most published data, female sex and old age do not appear to be risk factors. However, hypertension and electrolyte imbalance (mainly hypokalemia) are prevalent features. The detection of glycyrrhetinic acid in blood is very uncommon, and the diagnosis is essentially based on an accurate history taking. Conclusions: Although there is not a significant mortality rate, liquorice toxicity often requires hospitalization and therefore represents a significant health concern. Major pharmaceutical drug regulatory authorities should solicit public awareness about the potentially dangerous effects caused by excessive use of liquorice.
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spelling pubmed-105372372023-09-29 Liquorice Toxicity: A Comprehensive Narrative Review Ceccuzzi, Giovanna Rapino, Alessandro Perna, Benedetta Costanzini, Anna Farinelli, Andrea Fiorica, Ilaria Marziani, Beatrice Cianci, Antonella Rossin, Federica Cesaro, Alice Eleonora Spampinato, Michele Domenico De Giorgio, Roberto Guarino, Matteo Nutrients Review Background: Renowned since ancient times for its medical properties, liquorice is nowadays mainly used for flavoring candies or soft drinks. Continuous intake of large amounts of liquorice is a widely known cause of pseudo-hyperaldosteronism leading to hypertension and hypokalemia. These manifestations are usually mild, although in some cases may generate life-threatening complications, i.e., arrhythmias, muscle paralysis, rhabdomyolysis, and coma. In addition, liquorice has an important estrogenic-like activity. Methods: We summarized the current knowledge about liquorice and reviewed 104 case reports in both the English and Italian languages from inception to June 2023 concerning complications due to an excess of liquorice intake. Results: In contrast to most published data, female sex and old age do not appear to be risk factors. However, hypertension and electrolyte imbalance (mainly hypokalemia) are prevalent features. The detection of glycyrrhetinic acid in blood is very uncommon, and the diagnosis is essentially based on an accurate history taking. Conclusions: Although there is not a significant mortality rate, liquorice toxicity often requires hospitalization and therefore represents a significant health concern. Major pharmaceutical drug regulatory authorities should solicit public awareness about the potentially dangerous effects caused by excessive use of liquorice. MDPI 2023-09-05 /pmc/articles/PMC10537237/ /pubmed/37764649 http://dx.doi.org/10.3390/nu15183866 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ceccuzzi, Giovanna
Rapino, Alessandro
Perna, Benedetta
Costanzini, Anna
Farinelli, Andrea
Fiorica, Ilaria
Marziani, Beatrice
Cianci, Antonella
Rossin, Federica
Cesaro, Alice Eleonora
Spampinato, Michele Domenico
De Giorgio, Roberto
Guarino, Matteo
Liquorice Toxicity: A Comprehensive Narrative Review
title Liquorice Toxicity: A Comprehensive Narrative Review
title_full Liquorice Toxicity: A Comprehensive Narrative Review
title_fullStr Liquorice Toxicity: A Comprehensive Narrative Review
title_full_unstemmed Liquorice Toxicity: A Comprehensive Narrative Review
title_short Liquorice Toxicity: A Comprehensive Narrative Review
title_sort liquorice toxicity: a comprehensive narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10537237/
https://www.ncbi.nlm.nih.gov/pubmed/37764649
http://dx.doi.org/10.3390/nu15183866
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