We report a case of a 67-year-old woman with hypokalemic
rhabdomyolysis induced by pseudohyperaldosteronism. The pseudohyperaldosteronism in this case was caused by the administration of a
traditional Chinese medicine, which contained 2.0 g of licorice in the approved daily dose. She started to suffer from
hypertension and general
fatigue after taking the medication, but continued it for two years until admission after an episode of
diarrhea and
vomiting. On admission, severe
hypokalemia (1.6 mEq/L) and increased serum
creatinine kinase (8,778 IU/L) was noted. With the findings of a high transtubular
potassium concentration gradient (TTKG) in spite of low plasma
renin activity and a low plasma
aldosterone concentration, we suspected licorice-induced pseudohyperaldosteronism as the cause of her hypokalemic
rhabdomyolysis. The Chinese medicine was terminated, and she received appropriate hydration and
potassium replacement
therapy as judged by the value of TTKG with the result that her serum
potassium and
creatinine kinase levels were normalized without any more adverse events. Since it was only a low dose of licorice (2.0 g/day) that induced hypokalemic
rhabdomyolysis in this case, serum
electrolytes should be examined in all cases under the possible consumption of licorice.