title: A sweet tooth as the root cause of cardiac arrest.
abstract: A 71-year-old woman was admitted with hypotension and bradycardia. An electrocardiogram showed flattened T waves and increased U wave prominence, resulting in a long QT(U) syndrome. Her initial serum potassium level was 1.6 mmol/L (all other electrolytes, including magnesium, were normal). She suffered recurrent ventricular tachycardia and ventricular fibrillation arrest requiring direct current cardioversion and high-dose intravenous potassium chloride replacement. Systematic enquiry revealed that she had been constipated for a number of months and had resorted to consuming large quantities of liquorice on a daily basis for its laxative effects. Endocrinology review identified no primary abnormality of the renin- angiotensin- aldosterone axis, and the patient was diagnosed with hypokalemia secondary to liquorice overindulgence. Liquorice has a mineralocorticoid effect. If chronically consumed in large quantities, this effect may lead to severe depletion of whole-body potassium stores. The present case highlights a rare but important cause of hypokalemic cardiac arrest of which all acute care physicians should be aware.
authors.affiliation: Department of Cardiology, Toronto General Hospital, Toronto, Ontario. andrew.crean@uhn.on.ca
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Crean
authors.forename: Saif-El-Dean T
authors.initials: SE
authors.lastname: Abdel-Rahman
authors.forename: John Pierre
authors.initials: JP
authors.lastname: Greenwood
mesh_terms: D000368:Aged; D004562:Electrocardiography; D005260:Female; D006035:Glycyrrhiza / Q000009:adverse effects*; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000150:complications* / Q000503:physiopathology; D008133:Long QT Syndrome / Q000150:complications* / Q000175:diagnosis; D010946:Plants, Medicinal