[Major hypokalemia with rhabdomyolysis secondary to the intake of a nonalcoholic aniseed aperitif].

A case of exogenous hypermineralocorticism secondary to absorption of an alcohol-free liquorice beverage is reported here. The patient was a 53 year old man with known alcoholic liver cirrhosis who had stopped drinking alcohol one year earlier. He was admitted to the hospital for fever and myalgia without hypertension. Laboratory tests showed severe hypokalemia (1.7 mmol/l), metabolic acidosis and enzyme abnormalities compatible with rhabdomyolysis. Urinary potassium excretion was high. Plasma renin activity and aldosterone levels were low. Symptoms were those of exogenous hypermineralocorticism. One month earlier, the patient had drunk 0,25 1 per day of an alcohol-free licorice beverage for two weeks. Clinical and biological symptoms disappeared with potassium loading alone. Three weeks later, when serum potassium levels remained normal, the ingestion of the same amounts of the same beverage produced an important decrease in serum potassium levels. Intoxication by liquorice is a well-known cause of pseudoprimary hyperaldosteronism. But the case reported here has some unique features. It is, to our knowledge, the first case reported in the literature, although a few cases have been brought to the attention of the poison center in Marseille. The amount of beverage ingested was small (0.35 g/day of glycyrrhizinic acid) as compared to the usual threshhold of toxicity (0.7 g/day). The toxic effects lasted two weeks after discontinuing ingestion. Cirrhotic patients may be more susceptible than others but the main consumers of this type of beverage are presumably ex-alcoholics.