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Glycyrrhizic acid toxicity caused by consumption of licorice candy cigars

Published online by Cambridge University Press:  21 May 2015

Christine Johns
Christine Johns*
Affiliation:
Department of Emergency Medicine, University of Ottawa, Ottawa, Ont., The Ottawa Hospital Civic Campus, Ottawa, Ont.
*
Department of Emergency Medicine, University of Ottawa, The Ottawa Hospital Civic Campus, 1053 Carling Ave., Ottawa ON K1Y 4E9; [email protected]

Abstract

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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.

Keywords

licoriceglycyrrhizic acid toxicityhypermineralocorticoid syndrome
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 11 , Issue 1 , January 2009 , pp. 94 - 96
Copyright
Copyright © Canadian Association of Emergency Physicians 2009

References

1.Achar, KN, Abduo, TJ, Menon, NK, et al.Severe hypokalemic rhabdomyolysis due to ingestion of liquorice during Ramadan. Aust N Z J Med 1989;19:365–7.CrossRefGoogle ScholarPubMed
2.Cuspidi, C, Gelosa, M, Moroni, E, et al.Pseudo-Conn’s syndrome after habitual ingestion of liquorice. Report on various clinical cases [article in Italian]. Minerva Med 1981;72:825–30.Google ScholarPubMed
3.Lorenzin, F, Degen, C, Milani, A, et al.Pseudo-hyperaldosteronism caused by licorice. Pathogenetic considerations and presentation of a clinical case. Clin Ter 1990;132:55–8.Google Scholar
4.Lin, SH, Yang, SS, Chau, T, et al.An unusual case of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci 2003;325:153–6.Google Scholar
5.Elinav, E, Chajek-Shaul, T.Licorice consumption causing severe hypokalemic paralysis. Mayo Clin Proc 2003;78:767–8.Google Scholar
6.van Uum, SH.Liquorice and hypertension. Neth J Med 2005;63: 119–20.Google ScholarPubMed
7.Farese, RV Jr, Biglieri, EJ, Shackleton, CHL, et al.Licorice-induced hypermineralocorticoidism. N Engl J Med 1991;325:1223–7.Google Scholar
8.Subhuti, D.Safety issues affecting herbs: herbs that may increase blood pressure. Portland (OR): Institute for Traditional Medicine; 2003. Available:http://www.itmonline.org/arts/hypertension.htm (accessed 2008 Sept 19).Google Scholar
9.Natural Standard Research Collaboration. Licorice (Glycyrrhiza glabra L.) and DGL (deglycyrrhizinated licorice). Cambridge (MA): The Collaboration; 2008. Available:http://www.nlm.nih.gov /medlineplus/druginfo/natural/patient-licorice.html (accessed 2008 Sept 19).Google Scholar
10.Schonwald, S.Plant poisoning, licorice [article]. eMedicine 2008;Feb 13. Available:http://www.emedicine.com/emerg/topic 450.htm (accessed 2008 Sept 19).Google Scholar
11.Cinatl, J, Morgenstern, B, Bauer, G, et al.Glycyrrhizin, an active component of liquorice roots, and replication of SARS-associated coronavirus. Lancet 2003;361:2045–6.Google Scholar
12.Sigurjónsdóttir, HA, Franzson, L, Manhem, K, et al.Liquorice-induced rise in blood pressure: a linear dose-response relationship. J Hum Hypertens 2001;15:549–52.CrossRefGoogle Scholar
13.van Gelderen, CE, Bijlsma, JA, van Dokkum, W, et al.Glycyrrhizic acid: the assessment of a no effect level. Hum Exp Toxicol 2000;19:434–9.Google Scholar
14.De Klerk, GJ, Nieuwenhuis, MG, Beutler, JJ, et al.Hypokalemia and hypertension associated with use of liquorice flavoured chewing gum. BMJ 1997;314:731–2.Google Scholar
15.Armanini, D, Bonanni, G, Palermo, M, et al.Reduction of serum testosterone in men by licorice. N EnglJ Med 1999;341:1158.Google Scholar
16.Health Canada. Drugs and Health Products. Licorice. Available:http://www.hc-sc.gc.ca/dhp-mps/prodnatur/applications/licen-prod /monograph/mono_licorice-reglisse_e.html(accessed 2008 Sept 19).Google Scholar