Severe hypokalemia, rhabdomyolysis, muscle paralysis, and respiratory impairment in a hypertensive patient taking herbal medicines containing licorice.
A 93 year-old hypertensive woman was found to have severe hypokalemia (as low as 1.3 mEq/L) and developed paralysis of the all extremities associated with metabolic alkalosis, hypoxemia, hypercapnea, extremely high levels of creatine phosphokinase (up to 9280 U/L), myoglobin and myoglobinuria compatible with rhabdomyolysis. Plasma renin activity and aldosterone levels were below normal. She was found to have been taking licorice-containing herbal medicines for the last 7 years. With the discontinuation of the licorice-containing medicines and administration of spironolactone together with intravenous and oral potassium supplement, her serum potassium level was normalized and her clinical symptoms and hypertension improved within 2 weeks.
Yasue
Hirofumi
H
Division of Cardiovascular Medicine, Kumamoto Kinoh Hospital, Kumamoto Aging Research Institute, Kumamoto, Japan. yasue@juryo.or.jp <yasue@juryo.or.jp>
Itoh
Teruhiko
T
Mizuno
Yuji
Y
Harada
Eisaku
E
D000284:Administration, Oral; D000369:Aged, 80 and over; D005260:Female; D006035:Glycyrrhiza / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology; D007008:Hypokalemia / Q000097:blood / Q000209:etiology* / Q000503:physiopathology; D007275:Injections, Intravenous; D000451:Mineralocorticoid Receptor Antagonists; D010243:Paralysis / Q000209:etiology*; D008517:Phytotherapy / Q000009:adverse effects*; D011188:Potassium / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use; D012120:Respiration Disorders / Q000209:etiology*; D012206:Rhabdomyolysis / Q000209:etiology*; D012720:Severity of Illness Index; D013148:Spironolactone / Q000627:therapeutic use; D016896:Treatment Outcome
D000451:Mineralocorticoid Receptor Antagonists; D013148:Spironolactone; D011188:Potassium