The Root of the Problem: A Case Report of Licorice-Induced Hypokalemia

Abstract

Aim: To highlight the importance of comprehensive medication and travel history in the evaluation of hypokalemia in returning travellers. Methods: A case report of a 70-year-old female recently returned from China who presented with profound hypokalemia. Clinical evaluation included laboratory testing, medication review, and assessment of electrolyte levels including magnesium, renin, and aldosterone. Results: The patient was found to have severe hypokalemia requiring both intravenous and oral potassium supplementation. Magnesium was also low (0.66 mmol/L) and corrected to facilitate potassium repletion. Subsequent laboratory investigations revealed low plasma renin activity (0.16 ng/mL/hr) and low aldosterone level (<1.0 ng/dL) which suggests the possibility of herbal medications contributing to this as it was not in keeping with a primary endocrinopathy such as primary hyperaldosteronism. Conclusion: This case underscores the need for thorough history-taking, including travel and medication use, in patients with hypokalemia. Low renin and aldosterone levels pointed to a non-renal cause, prompting consideration of exogenous substances or supplements. Identifying the underlying etiology of hypokalemia is crucial for targeted treatment and prevention of recurrence.