Introduction: Licorice-induced pseudohyperaldosteronism is a crucial differential for hypokalaemia. We report a case of a life-threatening presentation to highlight the diagnostic and management considerations, and the need for public awareness measures.
Case presentation: A 71-year-old man with a history of hypertension on hydrochlorothiazide was admitted to the Intensive Care Unit (ICU) for severe hypokalaemia and hypertension. A thorough history revealed he had consumed approximately 800g of licorice confectionary over the preceding six weeks. Investigations revealed a potassium nadir of 1.9 mmol/L and metabolic alkalosis. The endocrine workup was consistent with pseudohyperaldosteronism, with suppressed plasma renin (<2.0 mU/L) and aldosterone (50 pmol/L) levels, and metabolic alkalosis.
Management and outcome: Management involved immediate cessation of licorice and hydrochlorothiazide. He required ICU admission with aggressive intravenous potassium replacement (approx. 800 mmol) and spironolactone. His potassium level normalised, and he was discharged safely.
Discussion: This case highlights the risk of life-threatening complication from excess licorice consumption. Though recognized as generally safe, toxicity becomes more likely above recommended levels and the public health concern of licorice in food items in food remains topical. A history of licorice intake should be considered in anyone presenting with hypokalaemia. There is a need for greater public awareness and clearer product labelling to mitigate the risk of severe adverse events.