title: [Clinical characteristics of five elderly patients with severe hypokalemia induced by glycyrrhizin derivatives].
abstract: Although hypokalemia is a common clinical problem, symptoms generally do not become manifest unless the serum potassium (K) falls rapidly. We encountered five cases with symptomatic severe hypokalemia (K<2.0 mEq/L) hospitalized for the past 15 months at our hospital. We examined the clinical characteristics and treatment of these patients. All five patients were women, and their mean age was 77.8 (73-82)years. They suffered from hypertension. Mean K level at admission was 1.66 (1.4-1.9) mEq/L and HCO3(-) was 48.3 (33.6-56.1) mmol/L. Plasma aldosterone level was low and plasma rennin activity was suppressed. All patients developed progressive muscle weakness with elevated creatinine phosphokinase. Three of the patients had received Chinese medicine which contained licorice, one received glycyrrhizin and the other one had received both. We diagnosed these cases as pseudoaldosteronism induced by glycyrrhizin. With discontinuation of the drugs and intravenous as well as oral K supplementation, serum K were normalized and clinical symptoms improved within 12 days. For one patient who developed cardiac dysfunction, concentrated K solution (230 mEq/L) was infused into the central vein. These findings show that glycyrrhizin ingestion should be kept in mind as a cause of an extreme degree of an hypokalemia, especially in elderly patients.
authors.affiliation: Division of Nephrology, Osaka Rosai Hospital, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Masaki
authors.initials: M
authors.lastname: Hatanaka
authors.forename: Jun
authors.initials: J
authors.lastname: Matsuda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kadoya
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takahashi
authors.forename: Tomoko
authors.initials: T
authors.lastname: Namba
authors.forename: Masanobu
authors.initials: M
authors.lastname: Takeji
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamauchi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000450:Aldosterone / Q000097:blood / Q000172:deficiency; D000471:Alkalosis; D000893:Anti-Inflammatory Agents / Q000009:adverse effects*; D004365:Drugs, Chinese Herbal / Q000009:adverse effects* / Q000737:chemistry; D005260:Female; D019695:Glycyrrhizic Acid / Q000009:adverse effects*; D006801:Humans; D006973:Hypertension; D007008:Hypokalemia / Q000139:chemically induced* / Q000188:drug therapy; D008517:Phytotherapy / Q000009:adverse effects; D011188:Potassium / Q000008:administration & dosage; D012083:Renin / Q000097:blood / Q000172:deficiency; D012206:Rhabdomyolysis / Q000139:chemically induced*; D012720:Severity of Illness Index; D013812:Therapeutics
chemical_list: D000893:Anti-Inflammatory Agents; D004365:Drugs, Chinese Herbal; D000450:Aldosterone; D019695:Glycyrrhizic Acid; D012083:Renin; D011188:Potassium