Licorice has been around for centuries and has been commercialized in the food, tobacco, and healthcare industry. Historically, its therapeutic benefits have been reaped in countless ways, including as a thirst sensation suppressor in battlefields,
flavoring agent in medicinal preparations,
antacid for gastric discomfort and
peptic ulcers, and even as an estrogenic agent in postmenopausal women. Licorice and its derivatives are recognized safe by the US Food and Drug Administration (FDA). Though FDA recognized the licorice to be a
food additive in certain concentrations, it has issued warnings against its use in at-risk group and in larger amount. However, it is a lesser known fact that
glycyrrhizic acid, the active component in licorice, can cause a
metabolic syndrome presenting as pseudohyperaldosteronism. Chronic consumption leads to the development of
hypertension, metabolic
alkalosis, and
hypokalemia. We present a patient who developed a sinus pause on telemetry and subsequent
syncope after presenting for evaluation of
hypertension and
hypokalemia. The patient had been ingesting a significant quantity of deglycyrrhizinated licorice for many years to alleviate postprandial epigastric
pain. Although seemingly benign
electrolyte disturbance, it is crucial to recognize that chronic consumption of licorice without strict regulation can lead to supraventricular and ventricular ectopics and
tachyarrhythmias with the potential to develop life-threatening arrhythmias including
ventricular tachycardia,
ventricular fibrillation, and
Torsades de Pointes.