Effect of eating liquorice on the renin-angiotensin aldosterone axis in normal subjects.

Epstein, Murray; Espiner, Eric A.; Donald, R. A.; Hughes, H.

doi:10.1136/bmj.1.6059.488

Cited by 108 publications

(38 citation statements)

References 2 publications

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“…Serum potassium concentrations fell by more than 0.3 mmol/L in 11 people, including four who had to be withdrawn from the study due to marked hypokalemia (4). These findings will not surprise senior physicians, who may recall episodes of serious potassium loss secondary to carbenoxolone, which is a liquorice-containing medication used within the past 20 years for the treatment of gastric ulceration.…”

Section: Discussionmentioning

confidence: 81%

A sweet tooth as the root cause of cardiac arrest

Crean

Abdel-Rahman

Greenwood

2009

Canadian Journal of Cardiology

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It has long been known that liquorice can induce a hypermineralocorticoid syndrome. We describe a case of severe liquorice-induced hypokalemia leading to recurrent nonsustained ventricular tachycardia and ventricular fibrillation (VF). Case presentationA 71-year-old Yorkshire (United Kingdom) woman collapsed unconscious at home and required direct current cardioversion for VF by the paramedic ambulance crew. On arrival at the hospital, the patient was intubated and was determined to be hypotensive (66/43 mmHg). The initial 12-lead electrocardiogram showed a junctional bradycardia of 40 beats/min, with flattened T waves and increased U wave prominence, resulting in a long QT(U) syndrome (Figure 1). Intravenous atropine had no appreciable effect; therefore, temporary transcutaneous pacing was used for 10 min, before the eventual return to sinus rhythm. The initial serum potassium level was 1.6 mmol/L (all other electrolytes, including magnesium, were within the normal range; estimated glomerular filtration rate was 55 mL/min/1.73 m 2 ). The acid-base balance was undisturbed. Therefore, high-dose potassium supplementation was started through a central venous line and she was transferred to the intensive care unit for further management.The patient's medical history included hypertension and a 'small' myocardial infarction in 2002. There was no antecedent history of gastrointestinal symptoms or conventional laxative use to account for her low serum potassium level. Her long-standing medications were bendroflumethiazide 2.5 mg once daily and lisinopril 20 mg once daily. All serum electrolytes were normal when they were checked by her general practitioner six months previously. However, 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. It transpired that she had favoured a local Yorkshire delicacy -Pontefract liquorice cakes.The following day, her serum potassium level increased to 2.9 mmol/L. Despite this, runs of nonsustained ventricular tachycardia continued. A further VF arrest followed, requiring intubation, direct current cardioversion and 2 min of cardiopulmonary resuscitation to restore cardiac output. Further aggressive intravenous potassium supplementation and intravenous magnesium sulphate was required to abolish ventricular arrhythmias. In total, 720 mmol intravenous and 312 mmol oral potassium chloride were required to restore serum potassium levels to the normal physiological range. During this time period, oral spironolactone and lisinopril were administered as an adjunct to maintain serum potassium levels and control arterial hypertension (bendroflumethiazide was temporarily stopped). 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). ...

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Section: Discussionmentioning

confidence: 81%

A sweet tooth as the root cause of cardiac arrest

Crean

Abdel-Rahman

Greenwood

2009

Canadian Journal of Cardiology

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“…Treatment with SNMC is not without side effects, which are seen in a minority of patients; the main side effects are hypertension, sodium and fluid retention, worsening ascites, and hypokalemia (44,45). Glycyrrhizin should be used cautiously in patients with a history of hypertension or renal failure or currently using cardiac glycosides.…”

Section: Glycyrrhizin (Licorice Root Extract)mentioning

confidence: 98%

Herbal Medicines for Liver Diseases

2005

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Herbal medicines have been used in the treatment of liver diseases for a long time. A number of herbal preparations are available in the market. This article reviews four commonly used herbal preparations: (1) Phyllanthus, (2) Silybum marianum (milk thistle), (3) glycyrrhizin (licorice root extract), and (4) Liv 52 (mixture of herbs). Phyllanthus has a positive effect on clearance of HBV markers and there are no major adverse effects; there are no data from randomized controlled trials on clinically relevant outcomes, such as progression of chronic hepatitis to cirrhosis and/or liver cancer, and on survival. Silymarin does not reduce mortality and does not improve biochemistry and histology among patients with chronic liver disease; however, it appears to be safe and well tolerated. Stronger neominophagen C (SNMC) is a Japanese preparation that contains 0.2% glycyrrhizin, 0.1% cysteine, and 2% glyceine. SNMC does not have antiviral properties; it primarily acts as an anti-inflammatory or cytoprotective drug. It improves mortality in patients with subacute liver failure and improves liver functions in patients with subacute hepatic failure, chronic hepatitis, and cirrhosis with activity. SNMC does not reduce mortality among patients with cirrhosis with activity. SNMC may prevent the development of hepatocellular carcinoma in patients with chronic hepatitis C, however, prospective data are lacking. Liv 52, an Ayurvedic hepatoprotective agent, is not useful in the management of alcohol-induced liver disease. Standardization of herbal medicines has been a problem and prospective, randomized, placebo-controlled clinical trials are lacking to support their efficacy. The methodological qualities of clinical trials of treatment with herbal preparations are poor. The efficacy of these herbal preparations need to be evaluated in rigorously designed, larger randomized, double-blind, placebo-controlled multicenter trials.

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“…In addition, the development of pseudoaldosteronism, characterized by sodium retention, exaggerated potassium excretion, and suppression of both renin and aldosterone was described in patients who took large amounts of licorice or glycyrrhizin for long periods [1,[6][7][8][9]. However, the alterations in blood pressure and electrolyte balance in patients taking licorice or glycyrrhizin were quantitatively variable, with some individuals showing little or no change, whereas others exhibited gross abnormalities [10,11]. The present study demonstrated two points in patients with chronic hepatitis treated with 546mg of glycyrrhizin.…”

Section: Introductionmentioning

confidence: 99%