[Hypokalemia with pseudo-hyperaldosteronism: Is it Lidl® syndrome?] / Hypokaliémie avec pseudo-hyperaldostéronisme : est-ce un syndrome de Lidl® ?

INTRODUCTION: Intoxication induced by glycyrrhizin is a common cause of hypokalaemia by pseudo-hyperaldosteronism. OBSERVATION: We hereby present the observation of a 68-year old patient hospitalised following a full hip-prosthesis operation after a deep hypokalaemia at 2.5mM was observed, with ECG signs (flat T waves and appearance of U waves). The kaliuresis was not adapted at 8,4mmol/mmol of creatininuria. We noted a history of axonal and demyelinising polyneuropathy, of psoriasis and chronic ethylism.The evolution after intravenous potassic supplementation and then per os was favourable leading to a normalisation of the blood and urinary potassic concentrations. The blood concentrations of renin and of aldosterone upon admission were lower than the detection threshold and the tests carried out 7 days later were normal with a plasmatic renin of 35.2 pg/mL and a plasmatic aldosterone of 74 pg/mL, therefore indicating a toxic cause. It is the interview of the patient that allowed for the diagnosis, identifying a daily, prolonged and important consumption (around 1L every 2-3 days for several years) of a pastis produced by supermarket brand Lidl®. The composition of the drink mentions 'liquorice infusion' without giving any more information as regards to the real concentration; it was later estimated at 170 mg/L by the distributor. DISCUSSION: The consumption of glycyrrhizin is a well-known aetiology for pseudo-hyperaldosteronism. It is commonly mentioned amongst excessive consumers of liquorice or of non-alcoholic anise drinks. Drinks that are derived from original pastis contain varying levels of glycyrrhizin, which is used as a flavour enhancer and can become toxic in cases of prolonged and important consumption.

Harmful effect of saline infusion in a patient with glycyrrhizic acid poisoning.

Alcohol-free licorice beverages contain glycyrrhizic acid. Excess glycyrrhizic acid is a well-known cause of excess mineralocorticoid syndrome. We report a case of glycyrrhizic acid poisoning in an abstinent alcoholic complicated by severe pulmonary edema following excessive hydration with intravenous normal saline.

Glycyrrhizic acid toxicity caused by consumption of licorice candy cigars.

A 49-year-old female physician presented with peripheral edema, weight gain and relative hypertension caused by the consumption of licorice candy cigars containing glycyrrhizic acid (GZA) found in natural licorice extract. Although the patient's response to GZA resolved spontaneously, emergency physician awareness of the toxic effects of natural licorice extract may avert symptom progression in early-identified cases. The benefits of natural licorice extract as a flavour enhancer and herbal medicine are recognized worldwide. The Canadian public is likely not generally aware of the toxic potential of GZA, or that it may be present in the following commonly consumed products: black licorice, chewing gum, herbal teas, soft drinks, tobaccos and herbal remedies for cough, stomach ailments and constipation. Emergency physicians should inquire about the consumption of products that may contain natural licorice extract when patients present with unexplained hypertension, hypokalemia, edema, rhabdomyolysis or myoglobinuria.

[Rhabdomyolysis with major hypokalemia secondary to chronic glycyrrhizic acid ingestion]. / Rhabdomyolyse liée à une hypokaliémie profonde par intoxication chronique à la glycyrrhizine.

Intoxication by glycyrrhizic acid is a well-known cause of the apparent mineralocorticoid excess syndrome. It causes hypokalemia by inhibiting the enzyme 11-beta-hydroxysteroid dehydrogenase. We report a case of hypokalemic rhabdomyolysis secondary to chronic glycyrrhizic acid intoxication.