# A Case of Hypokalemia Caused by the Consumption of Licorice-Containing Herbal Tea

## TL;DR

A patient developed low potassium levels from drinking licorice-containing herbal tea, which can mimic a hormone disorder and requires careful diagnosis.

## Contribution

This case highlights licorice-induced hypokalemia in a patient on an SGLT2 inhibitor, emphasizing the need for diagnostic awareness.

## Key findings

- Licorice consumption caused pseudo-hyperaldosteronism and hypokalemia in a patient with diabetes and cancer.
- Glycyrrhetinic acid from licorice activates mineralocorticoid receptors, contributing to electrolyte imbalance.
- Treatment included discontinuing licorice and using mineralocorticoid receptor antagonists.

## Abstract

Hypokalemia can have many etiologies, of which licorice toxicity is notable but often overlooked. Licorice is being increasingly used as a component in herbal formulations and holistic remedies. We present a case of licorice-induced hypokalemia due to herbal tea formulation in a patient with a history of type 2 diabetes mellitus and metastatic adenocarcinoma. This case highlights a unique presentation of pseudo-hyperaldosteronism due to licorice consumption with concurrent use of a sodium-glucose cotransporter (SGLT2) inhibitor, requiring a high index of suspicion for diagnosis. Glycyrrhetinic acid (GA) is one of the active metabolites of licorice, which is responsible for intracellular cortisol accumulation and activation of mineralocorticoid receptors. Therefore, in addition to removing the offending agent, mineralocorticoid receptor antagonists can also be used in treatment.