Hypokalemia with uncontrolled arterial hypertension due to pseudohyperaldosteronism syndrome in association with therapeutic doses of glycyrrhizic acid intake
Abstract. Hypokalemia has a wide range of possible causes and is associated with the risk of serious complications. The article presents a rare clinical case of observation of a patient with persistent hypokalemia and uncontrolled arterial hypertension, which developed due to pseudohyperaldosteronism syndrome associated of taking therapeutic doses of glycyrrhizic acid. The presented clinical case illustrates the importance of careful collection of anamnesis, including drug history, in all patients, as well as increased vigilance regarding secondary causes of the development of arterial hypertension and adverse events associated with taking a wide range of different drugs (including those containing glycyrrhizic acid), especially in the elderly and / or patients with liver disease.Kotova E.O., Arisheva O.S., Misan I.A.
Keywords
hypokalemia
arterial hypertension
pseudohyperaldosteronism
glycyrrhizic acid
References
1. Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: A contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med. 2000;160(16):2429–36.
PMID: 10979053. https://doi.org/10.1001/archinte.160.16.2429
2 Проект рекомендаций. Первичный гиперальдостеронизм. Минздрав России. 2021 г. Доступ: https://rae-org.ru/system/files/documents/pdf/kr_pga_20.09.2021_4.pdf (дата обращения – 19.08.2023). (Draft guidelines. Primary hyperaldosteronism. Ministry of Healthcare of Russia. 2021. URL: https://rae-org.ru/system/files/documents/pdf/kr_pga_20.09.2021_4.pdf (date of access – 19.08.2023) (In Russ.)).
3. Khan FY. Rhabdomyolysis: A review of the literature. Neth J Med. 2009;67(9):272–83. PMID: 19841484.
4. Козловская Л.В., Фомин В.В., Моисеев С.В., Попова Е.Н. Гипокалиемия у взрослых. Справочник поликлинического врача. 2005;(3):3–8. (Kozlovskaya LV, Fomin VV, Moiseev SV, Popova EN. Hypokalemia in adults. Spravochnik poliklinicheskogo vracha = Handbook of a Polyclinic Physician. 2005;(3):3–8 (In Russ.)). EDN: WWMDFF.
5. Takeda R, Morimoto S, Uchida K, Nakai T, Miyamoto M, Hashiba T et al. Prolonged pseudoaldosteronism induced by glycyrrhizin. Endocrinol Jpn. 1979;26 (5):541–47.
PMID: 393503. https://doi.org/10.1507/endocrj1954.26.541
6. Янг У., Ладыгина Д.О., Балутина О.В., Бельцевич Д.Г. Первичный гиперальдостеронизм: подход Клиники Мэйо. Терапевтический архив. 2020;92(10):83–87. (Young W, Ladygina DO, Balutina OV, Beltsevich DG. Primary aldosteronism: The Mayo Clinic approach. Terapevticheskiy arkhiv = Therapeutic Archive. 2020;92(10):83–87 (In Russ.)).
EDN: GQJJYU. https://doi.org/10.26442/00403660.2020.10.000754
7. Атлас ареалов и ресурсов лекарственных растений СССР. М.: Главное управление геодезии и картографии при Совете Министров СССР. 1983; 340 с. (Atlas of areas and resources of medicinal plants of the USSR. Moscow: Main Directorate of Geodesy and Cartography under the Council of Ministers of the USSR. 91983; 340 pp. (In Russ.)). ISBN: 978-5-0000-0000-0.
8. Василенко А.Ф., Карпова М.И., Сергейцев А.Н., Заляутдинова Р.Ю. Случай гипокалиемического паралича на фоне приема терапевтических доз препарата, содержащего корень солодки. Нервно-мышечные болезни. 2019;9(4):57–60. (Vasilenko AF, Karpova MI, Sergeitsev AN, Zaliautdinova RYu. Case of hypokalemic paralysis due to use of drug containing therapeutic doses liquorice root. Nervno-myshechnye bolezni = Neuromuscular Diseases. 2019;9(4):57–60 (In Russ.)).
EDN: BDWZSP. https://doi.org/10.17650/2222-8721-2019-9-4-57-60
9. Кейзер Н.П., Жарский С.Л., Богатков С.Д., Сысоев В.В. Случай гипокалиемии и рабдомиолиза при хроническом отравлении солодкой. Дальневосточный медицинский журнал. 2015;(1):78–81. (Keizer NP, Zharskiy SL, Bogatkov SD, Sysoev VV. Hypokalemia and rhabdomyolysis caused by chronic lycorice poisoning. Dal’nevostochnyy meditsinskiy zhurnal = Far Eastern Medical Journal. 2015;(1):78–81 (In Russ.)). EDN: TNFZLV.
10. Супонева Н.А., Пирадов М.А., Никитин С.С., Алферова В.П. Острый гипокалиемический паралич вследствие передозировки препарата, содержащего корень солодки. Анналы клинической и экспериментальной неврологии. 2008;2(1):47–51. (Suponeva NA, Piradov MA, Nikitin SS, Alferova VP. Acute hypokalemic paralysis due to an overdose of a drug containing licorice root. Annaly klinicheskoy i eksperimental’noy nevrologii = Annals of Clinical and Experimental Neurology. 2008;2(1):47–51 (In Russ.)).
EDN: MTCWMR.
11. Маевская М.В. Особенности терапии неалкогольной жировой болезни печени у коморбидных пациентов. Медицинский совет. 2020;(21):136–143. (Maevskaya MM. Features of the therapy of non-alcoholic fatty liver disease in comorbid patients. Meditsinskiy sovet = Medical Council. 2020;(21):136–143 (In Russ.)).
EDN: MFVNDD. https://doi.org/10.21518/2079-701X-2020-21-136-143
12. Attou R, Redant S, Honore PM, Preseau T, Hantson P, De Bels D. Liquorice intoxication can lead to cardiac arrest! Case Rep Emerg Med. 2020:2020:3727682.
PMID: 33029435. PMCID: PMC7527885. https://doi.org/10.1155/2020/3727682
13. (Luchon L, Meyrier A, Paillard F. Hypokalemia without arterial hypertension by licorice poisoning. Nephrologie. 1993;14(4):177–81
(In French)). PMID: 8232712.
14. van Rossum TG, Vulto AG, de Man RA, Brouwer JT, Schalm SW. Review article: Glycyrrhizin as a potential treatment for chronic hepatitis C. Aliment Pharmacol Ther. 1998;12(3):199–205.
PMID: 957025. https://doi.org/10.1046/j.1365-2036.1998.00309.x
15. Kwon YJ, Son DH, Chung TH, Lee YJ. A Review of the pharmacological efficacy and safety of licorice root from corroborative clinical trial findings. J Med Food. 2020;23(1):12–20.
PMID: 31874059. https://doi.org/10.1089/jmf.2019.4459
16. Peninkilampi R, Eslick EM, Eslick GD. The association between consistent licorice ingestion, hypertension and hypokalemia:
A systematic review and meta-analysis. J Hum Hypertens. 2017:31(11):699–707.
PMID: 28660884. https://doi.org/10.1038/jhh.2017.45
17. Food U.S. GRAS status of licorice (Glycyrrhiza), ammoniated glycyrrhizin and monoammonium glycyrrhizinate. Federal Register. 1985; 5099 pp.
18. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Nakama Y et al. Clinical profile of patients with symptomatic glycyrrhizin-induced hypokalemia. J Am Geriatr Soc. 2008;56(8):1579–81.
PMID: 18808610. https://doi.org/10.1111/j.1532-5415.2008.01781.x
19. Nazari S, Rameshrad M, Hosseinzadeh H. Toxicological effects of Glycyrrhiza glabra (Licorice): A review toxic effect. Phytother Res. 2017;31(11):1635–50.
PMID: 28833680. https://doi.org/10.1002/ptr.5893
About the Authors
Elizaveta O. Kotova, MD, Dr. Sci. (Medicine), associate professor, associate professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine of RUDN University, cardiologist at V.V. Vinogradov University Clinical Hospital (branch) of RUDN University. Address: 117292, Moscow, 61/1 Vavilova St.E-mail: kotova_eo@pfur.ru
ORCID: http://orcid.org/0000-0002-9643-5089. SPIN-code: 6397-6480
Olga S. Arisheva, MD, PhD (Medicine), associate professor of the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine, RUDN University, V.V. Vinogradov University Clinical Hospital (branch) of RUDN University. Address: 117292, Moscow, 61/1 Vavilova St.
E-mail: olga.arisheva@yandex.ru
ORCID: http://orcid.org/0000-0002-2964-0568. SPIN-code: 7556-0455
Irina A. Misan, MD, PhD (Medicine), assistant at the Department of internal medicine with a course in cardiology and functional diagnostics named after academician V.S. Moiseyev of the Institute of clinical medicine, RUDN University. Address: 117292, Moscow, 61/1 Vavilova St.
E-mail: irina.misan20@gmail.com
ORCID: http://orcid.org/0000-0002-3223-128X. SPIN-code: 2273-4624
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