Licorice Ingestion; An Unusual Cause of Rhabdomyolysis and Acute Renal Failure

Licorice root has glycyrrhizic acid as the active ingredient and is responsible for a primary hyperaldosteronism-like syndrome with hypokalemia, metabolic alkalosis, and hypertension, typically accompanying low aldosterone. Herein, we present a rare complication of licorice consumption with acute renal failure. A 49-year-old male patient was admitted to emergency department with generalized muscle pain/ weakness, nausea, and dark urine. He was suffering from confusion and somnolence and the general condition was moderate. At laboratory assessment, potassium was 2.3 mEq/L, sodium 141 mEq/L, urea 146 mg/dl, creatinine 6.24 mg/dl, and total creatine kinase 4597 U/L. He had metabolic alkalosis (pH 7.59, HCO3-37.2 mmol/L). Hemodialysis was performed because of uremic neurological symptoms. His detailed anamnesis revealed consumption of herbal medication for the last 1.5 years to treat gastric complaints. The herbal medication included 16 gr licorice root powder (similar to 600-750 mg glycyrrhizic acid) per 100 gr. The plasma aldosterone concentration was significantly suppressed [1.6 pg/ml (normal; 38.1-300 pg/mL)]. Under these conditions, our final diagnosis was hypokalemic rhabdomyolysis and acute renal failure due to licorice ingestion. We present a rare life-threating effect of licorice ingestion in this report. Furthermore, we want to draw attention to the importance of a detailed medical history, including the use of herbal medications and regional traditional characteristics to confirm the diagnosis.