Licorice induced hypokalemia, edema, and thrombocytopenia

Mustafa Kemal University, Turkey.
Human & Experimental Toxicology (Impact Factor: 1.75). 05/2012; 31(12). DOI: 10.1177/0960327112446843
Source: PubMed


Licorice originates from the root of Glycyrrhiza glabra, which has a herbal ingredient, glycyrrhizic acid, and has a mineralocorticoid-like effect. Chronic intake of licorice induces a syndrome similar to that found in primary hyperaldosteronism. Excessive intake of licorice may cause a hypermineralocorticoidism-like syndrome characterized by sodium and water retention, hypertension, hypokalemia, metabolic alkalosis, low-renin activity, and hypoaldosteronism. In this case report, an association of hypokalemia, edema, and thrombocytopenia that is developed due to the excessive intake of licorice is presented. There are case reports in the literature, which suggest that toxicity findings may emerge with hyperaldosteronism-like manifestations such as hypokalemia, edema, and hypertension. However, any knowledge of thrombocytopenia as a resultant was not encountered among these reported toxic effects. Our case is important because it shows that the excessive intake of licorice may cause a toxic effect in the form of thrombocytopenia. This report is the first presented case to show thrombocytopenia due to licorice syrup consumption.

Download full-text


Available from: Ali Karakuş, Apr 18, 2015
11 Reads
  • Source
    • "Together, these findings suggest that early retinal neuropathy induced by diabetes is, at least in part, attributable to diabetes-induced upregulation of HMGB1 expression and that inhibiting the release of HMGB1 with constant intake of GA results in less diabetes-induced retinal neuropathy. It is important to note that excessive intake of licorice may cause hypermineralocorticoidism-like syndrome characterized by sodium and water retention, potassium loss, edema, increased blood pressure, metabolic alkalosis, and depression of rennin-angiotensin-aldosterone system [50, 51]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To test the hypothesis that increased expression of proinflammatory cytokine high-mobility group box-1 (HMGB1) in epiretinal membranes and vitreous fluid from patients with proliferative diabetic retinopathy and in retinas of diabetic rats plays a pathogenetic role in mediating diabetes-induced retinal neuropathy. Retinas of 1-month diabetic rats and HMGB1 intravitreally injected normal rats were studied using Western blot analysis, RT-PCR and glutamate assay. In addition, we studied the effect of the HMGB1 inhibitor glycyrrhizin on diabetes-induced biochemical changes in the retina. Diabetes and intravitreal injection of HMGB1 in normal rats induced significant upregulation of HMGB1 protein and mRNA, activated extracellular signal-regulated kinase 1 and 2 (ERK1/2), cleaved caspase-3 and glutamate; and significant downregulation of synaptophysin, tyrosine hydroxylase, glutamine synthetase, and glyoxalase 1. Constant glycyrrhizin intake from the onset of diabetes did not affect the metabolic status of the diabetic rats, but it significantly attenuated diabetes-induced upregulation of HMGB1 protein and mRNA, activated ERK1/2, cleaved caspase-3, and glutamate. In the glycyrrhizin-fed diabetic rats, the decrease in synaptophysin, tyrosine hydroxylase, and glyoxalase 1 caused by diabetes was significantly attenuated. These findings suggest that early retinal neuropathy of diabetes involves upregulated expression of HMGB1 and can be ameliorated by inhibition of HMGB1.
    Mediators of Inflammation 09/2014; 2014(11):746415. DOI:10.1155/2014/746415 · 3.24 Impact Factor
  • Source
    • "Glycyrrhizin (glycyrrhizic acid and glycyrrhizinate), the active metabolite in licorice, induces pseudohyperaldosteronism by inhibiting the 11-β- hydroxysteroid dehydrogenase type 2. 11-β-hydroxysteroid dehydrogenase type 2 converts active glucocorticoid cortisol to locally inactive cortisone, which results in the activation of renal mineralocorticoid receptors by cortisol and a stat of apparent mineralocorticoid excess. Thus, excessive intake of licorice may cause hypokalemia (Celik et al., 2012). Poor nutritional state might be another risk factor that contributed to hypokalemia in cough mixture abusers. "
    [Show abstract] [Hide abstract]
    ABSTRACT: In past 2 decades, nonmedical consumption of cough mixture has become a serious social problem in certain regions of China. Cough mixture abuse causes psychiatric symptoms. Moreover, there has been an increasing concern about the physical disorders associated with cough mixture abuse. A retrospective chart review of hypokalemia related to cough mixture abuse between January 2009 and December 2012 was conducted in Guangzhou Brain Hospital, China. The charts were reviewed for 34 subjects with cough mixture abuse. Seven of 34 cough mixture abusers (20.6%) presented hypokalemia, with symptoms ranged from mild to severe limb weakness. Hypokalemia in these patients reduced after normalization of potassium. A high incidence of hypokalemia presents in cough mixture abusers. Cough mixture abuse might be one of the secondary causes of hypokalemia paralysis in young patients presenting to emergency departments.
    Journal of Addiction Medicine 04/2014; 8(3). DOI:10.1097/ADM.0000000000000033 · 1.76 Impact Factor
  • Source
    • "While R. carthamoides contains natural and low toxicity compounds [21], ERC elicited excellent outcomes without inducing side effects such as diarrhea, and in the present study, none of the animals died in the course of experiment (data not shown). In this emerging context, there are case reports in the literature that suggest that extensive intake of licorice may cause development of hypokalemia, edema, hypertension, and thrombocytopenia [39]. Ellagic acid (up to 40.0% in studied EPG) could induce a hypercoagulation state in mice, rats, and rabbits [40]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Rhaponticum cathamoides (RC) is an endemic wild Siberian herb with marked medicinal properties that are still poorly understood. The aim of this study is to investigate the therapeutic potential of RC extract (ERC) compared to the effects of Glycyrrhiza glabra (EGG) and Punica granatum extracts (EPG) in a rat model with high-fat diet-(HFD)-induced signs of metabolic syndrome; therefore, this study addresses a significant global public health problem. Six-month-old male Wistar Albino Glaxo rats were subjected to eight weeks of a standard diet (SD), HFD, or HFD in which ERC, EGG, or EPG powders were incorporated at 300 mg/kg/day. The serum lipid profile, corticosterone and cytokine concentrations, glucose tolerance, systolic blood pressure, triacylglycerol accumulation, and PPARalpha DNA-binding activities in the liver samples were determined. In contrast to EGG and EPG, an ERC supplement significantly reduced the weight of epididymal tissue (19.0%, p < 0.01) and basal serum glucose level (19.4%, p < 0.05). ERC improved glucose intolerance as well as dyslipidemia more efficiently than EGG and EPG. EGG but not ERC or EPG supplementation decreased systolic blood pressure by 12.0% (p < 0.05). All of the tested extracts reduced serum IL6 and corticosterone levels induced by HFD. However, the lowering effects of ERC consumption on the serum TNF-alpha level and its restoring effect on the adrenal corticosterone level significantly exceeded the improvements induced by EGG and EPG. ERC intake also reduced triacylglycerol accumulation and increased the PPARalpha DNA-binding activity in the liver more significantly than EGG and EPG. ERC powder supplementation improved glucose and lipid metabolism more significantly than EGG and EPG in rats fed on HFD, supporting the strategy of R. carthamoides use for safe relief of metabolic syndrome and its related disturbances such as inflammation, stress, and hepatic steatosis.
    BMC Complementary and Alternative Medicine 01/2014; 14(1):33. DOI:10.1186/1472-6882-14-33 · 2.02 Impact Factor
Show more