An autopsy case of licorice-induced hypokalemic rhabdomyolysis associated with acute renal failure: special reference to profound calcium deposition in skeletal and cardiac muscle.
A 78-year-old man was hospitalized because of muscular weakness and acute renal failure. He had been taking glycyrrhizin (280 mg/day) for the last 7 years. Hypertension was noted in his history. Serum potassium was 1.9 mEq/l with metabolic alkalosis. There was hyporeninemic hypoaldosteronism. Serum enzymes, including GOT, LDH and CPK were markedly elevated. In addition, serum myoglobin was as high as 46 micrograms/ml with massive myoglobinuria. Oliguria occurred and blood urea nitrogen and serum creatinine rapidly elevated from 20.9 to 87 mg/dl and from 1.3 to 6.7 mg/dl, respectively. Profound calcium deposition was found in the damaged skeletal muscles, including the quadriceps femoris, axillar, neck, and cardiac muscles. These results indicate that licorice-induced pseudoaldosteronism produces hypokalemic rhabdomyolysis, resulting in acute renal failure and profound deposition of calcium into the damaged skeletal and cardiac muscles.
b1p4rtment of Medicine, Jichi Medical School, Tochigi, Japan.
T
T
Saito
Y
Y
Tsuboi
G
G
Fujisawa
N
N
Sakuma
K
K
Honda
K
K
Okada
K
K
Saito
S
S
Ishikawa
T
T
Saito
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000368:Aged; D002118:Calcium / Q000378:metabolism*; D006034:Glycyrrhetinic Acid / Q000009:adverse effects / Q000031:analogs & derivatives*; D019695:Glycyrrhizic Acid; D006801:Humans; D006929:Hyperaldosteronism / Q000139:chemically induced; D007008:Hypokalemia / Q000139:chemically induced* / Q000378:metabolism; D008297:Male; D018482:Muscle, Skeletal / Q000378:metabolism*; D009206:Myocardium / Q000378:metabolism*; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000378:metabolism
D019695:Glycyrrhizic Acid; D006034:Glycyrrhetinic Acid; D002118:Calcium