Tetraparesis with Major Hypokalaemia and Rhabdomyolysis Induced by Chronic Liquorice Ingestion

Chronic ingestion of liquorice induces a syndrome with findings similar to those for primary hyperaldosteronism. This is characterized by hypokalaemia, hypertension, metabolic alkalosis and suppression of the renin-aldosterone system. We describe a 30-year-old woman who, with a plasma potassium level of 1.5 mmol/l, presented with tetraparesis and severe rhabdomyolysis (CK up to 35,460 U/l). She admitted to a daily consumption of nearly 300 g of liquorice sweets during the previous 6 months. This case emphasizes the importance of a detailed anamnesis, which is essential for diagnosis, avoids unnecessary and expensive investigations and reduces the duration of hospitalization. LEARNING POINTS: Liquorice, the root of Glycyrrhiza glabra, has been used throughout the millennia for its taste and for medicinal purposes. Chronic ingestion of liquorice can mimic primary hyperaldosteronism. It is important for physicians to keep liquorice consumption in mind as a cause of hypokalaemic paralysis and rhabdomyolysis.