A hidden cause of hypokalemic paralysis in a patient with prostate cancer.
Hypokalemic paralysis is a medical emergency due to the risks of cardiac arrhythmia, respiratory failure, and rhabdomyolysis. Besides supplementing patients with KCl to hasten recovery, the astute physician must search for the underlying cause to avoid missing a treatable and curable disorder. We report on an elderly Korean man who presented with marked limb paralysis, myalgias, and mild hypertension. He had prostate cancer treated with orchiectomy and hormone therapy 2 years previously. The major biochemical abnormalities were hypokalemia (K+: 1.7 mmol/l) associated with high renal K+ wasting and metabolic alkalosis (HCO3-: 42.6 mmol/l). Low plasma renin activity, low aldosterone concentration, and normal cortisol concentration pointed to a state of pseudohyperaldosteronism. While reviewing his drug history, the patient revealed he had been consuming eight packs (100 ml/pack) of a Korean herbal tonic daily to treat his prostate cancer for the past 2 months. A significant amount of glycyrrhizic acid (0.23 mg/ml), an active ingredient of licorice, was detected in the tonic. Discontinuation of the herbal tonic along with KCl supplementation achieved recovery in 2 weeks. As many complementary/alternative medicines for cancer contain licorice, this must be kept in mind as a cause of hypokalemia in cancer patients.
Cheng
Chih-Jen
CJ
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Chen
Yeong-Hwang
YH
Chau
Tom
T
Lin
Shih-Hua
SH
D000368:Aged; D005500:Follow-Up Studies; D006035:Glycyrrhiza / Q000009:adverse effects*; D006801:Humans; D020514:Hypokalemic Periodic Paralysis / Q000139:chemically induced* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008517:Phytotherapy / Q000009:adverse effects* / Q000379:methods; D011189:Potassium Chloride / Q000627:therapeutic use; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018570:Risk Assessment; D012651:Self Medication / Q000009:adverse effects; D013624:Taiwan
D011189:Potassium Chloride