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Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes

Torsades de pointes (TdP) is a life-threatening cardiac arrhythmia that can result from QT interval prolongation, sometimes secondary to medication adverse effects and electrolyte derangements. We present a 95-year-old Hispanic male with advanced chronic kidney disease (CKD) that was evaluated for d...

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Autores principales: Molina-Lopez, Victor, Engel-Rodriguez, Andrew, Escabi-Mendoza, Jose
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Cureus 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949741/
https://www.ncbi.nlm.nih.gov/pubmed/36843745
http://dx.doi.org/10.7759/cureus.34126
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author Molina-Lopez, Victor
Engel-Rodriguez, Andrew
Escabi-Mendoza, Jose
author_facet Molina-Lopez, Victor
Engel-Rodriguez, Andrew
Escabi-Mendoza, Jose
author_sort Molina-Lopez, Victor
collection PubMed
description Torsades de pointes (TdP) is a life-threatening cardiac arrhythmia that can result from QT interval prolongation, sometimes secondary to medication adverse effects and electrolyte derangements. We present a 95-year-old Hispanic male with advanced chronic kidney disease (CKD) that was evaluated for dizziness and progressive weakness. The diagnosis of severe symptomatic hypokalemia and QT prolongation was made, and the patient was admitted for telemetry monitoring and aggressive intravenous electrolyte replacements. While under observation, the patient experienced syncope due to ventricular tachycardia (VT) with episodes of torsades de pointes. Due to refractory potassium depletion and hypertension, workup for hyperaldosteronism revealed renal potassium wasting, inappropriately normal plasma renin levels, and almost undetectable aldosterone levels. Careful analysis revealed the excessive chronic daily ingestion of licorice-containing candy twists and tea, which may cause pseudohyperaldosteronism. Licorice is a commonly used natural product that is available in many forms. It is sometimes used as a natural supplement and as a sweetener that can be widely found in many food products. Excessive ingestion can lead to apparent mineralocorticoid excess, reduced plasma potassium, sodium retention, hypertension, and metabolic alkalosis. Hypokalemia can be severe in some patients and lead to fatal cardiac arrhythmias such as ventricular tachycardia and torsades de pointes. Careful analysis is essential in cases of refractive hypokalemia and renal potassium wasting, especially in elderly patients with underlying renovascular disease.
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spelling pubmed-99497412023-02-24 Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes Molina-Lopez, Victor Engel-Rodriguez, Andrew Escabi-Mendoza, Jose Cureus Cardiology Torsades de pointes (TdP) is a life-threatening cardiac arrhythmia that can result from QT interval prolongation, sometimes secondary to medication adverse effects and electrolyte derangements. We present a 95-year-old Hispanic male with advanced chronic kidney disease (CKD) that was evaluated for dizziness and progressive weakness. The diagnosis of severe symptomatic hypokalemia and QT prolongation was made, and the patient was admitted for telemetry monitoring and aggressive intravenous electrolyte replacements. While under observation, the patient experienced syncope due to ventricular tachycardia (VT) with episodes of torsades de pointes. Due to refractory potassium depletion and hypertension, workup for hyperaldosteronism revealed renal potassium wasting, inappropriately normal plasma renin levels, and almost undetectable aldosterone levels. Careful analysis revealed the excessive chronic daily ingestion of licorice-containing candy twists and tea, which may cause pseudohyperaldosteronism. Licorice is a commonly used natural product that is available in many forms. It is sometimes used as a natural supplement and as a sweetener that can be widely found in many food products. Excessive ingestion can lead to apparent mineralocorticoid excess, reduced plasma potassium, sodium retention, hypertension, and metabolic alkalosis. Hypokalemia can be severe in some patients and lead to fatal cardiac arrhythmias such as ventricular tachycardia and torsades de pointes. Careful analysis is essential in cases of refractive hypokalemia and renal potassium wasting, especially in elderly patients with underlying renovascular disease. Cureus 2023-01-24 /pmc/articles/PMC9949741/ /pubmed/36843745 http://dx.doi.org/10.7759/cureus.34126 Text en Copyright © 2023, Molina-Lopez et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Cardiology
Molina-Lopez, Victor
Engel-Rodriguez, Andrew
Escabi-Mendoza, Jose
Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes
title Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes
title_full Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes
title_fullStr Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes
title_full_unstemmed Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes
title_short Close Call From a Sweet Twist: A Case of Licorice-Induced Torsades De Pointes
title_sort close call from a sweet twist: a case of licorice-induced torsades de pointes
topic Cardiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9949741/
https://www.ncbi.nlm.nih.gov/pubmed/36843745
http://dx.doi.org/10.7759/cureus.34126
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