Acute hypokaliemic paralysis as a result of licorice overdose

We present the first case report of licorice overdose in Russian literature. 28-year-old man had severe untreatable arterial hypertension, hypokaliemia, quadriparesis and pain in the calf after acute respiratory disease. Additional laboratory tests disю covered metabolic alkalosis, breath dysfunction, myoglobinuria and very high level of creatine phosphokinase in serum. It was discovered that this man was a codeineюabuser and took combined medicine containing codeine and licorice («Codelac») which is free for sale without prescription in pharmacies in Russia. The dose of licorice was up to 12 g per day in the course of half a year (up to 60 pills per day). The prescription of aldosterone antagonist was successful, and after 3 weeks of taking spironolactone the patient’s condition and all laboratory tests became normal. Licorice inhibits 11-beta-hydroxisteroid dehyю drogenase type 2 and leads to symptomatology of secondary hyperaldosteronism. There are many case reports of licorice overdose by old people with chronic obstructive syndromes in the medical literature. Some cases result to lethal outcome due to breath dysfunction with apnoea. We consider that codeineю abusers who are taking free for sale medicines containing codeine and licorice are in the risk group for licorice overdose.