Yang LY, Yin JH, Yang J, Ren Y, Xiang CY, Wang CY. Liquorice-induced severe hypokalemic rhabdomyolysis with Gitelman syndrome and diabetes: A case report. World J Clin Cases 2019; 7(10): 1200-1205 [PMID: 31183353 DOI: 10.12998/wjcc.v7.i10.1200]
Corresponding Author of This Article
Jin-Hua Yin, MD, Assistant Professor, Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, No. 85, South Jiefang Road, Taiyuan 030001, Shanxi Province, China. yinjjhh@163.com
Research Domain of This Article
Medicine, Research & Experimental
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. May 26, 2019; 7(10): 1200-1205 Published online May 26, 2019. doi: 10.12998/wjcc.v7.i10.1200
Liquorice-induced severe hypokalemic rhabdomyolysis with Gitelman syndrome and diabetes: A case report
Lu-Yang Yang, Jin-Hua Yin, Jing Yang, Yi Ren, Chen-Yu Xiang, Chun-Yan Wang
Lu-Yang Yang, Jing Yang, Chen-Yu Xiang, Chun-Yan Wang, Department of Endocrinology, First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Jin-Hua Yin, Yi Ren, Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, Taiyuan 030001, Shanxi Province, China
Author contributions: All authors contributed to this paper.
Supported bythe Fund Program for Scientific Activities of Selected Returned Overseas Professionals in Shanxi Province, No. 2017-397.
Informed consent statement: The patient provided written informed consent to the publication of this case report.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jin-Hua Yin, MD, Assistant Professor, Department of Endocrinology, First Hospital of Shanxi Medical University, Shanxi Medical University, No. 85, South Jiefang Road, Taiyuan 030001, Shanxi Province, China. yinjjhh@163.com
Telephone: +86-351-4639756 Fax: +86-351-4639758
Received: January 30, 2019 Peer-review started: January 31, 2019 First decision: April 18, 2019 Revised: April 25, 2019 Accepted: May 2, 2019 Article in press: May 2, 2019 Published online: May 26, 2019 Processing time: 116 Days and 20.6 Hours
Abstract
BACKGROUND
Licorice-induced severe hypokalemic rhabdomyolysis is clinically rare. Gitelman syndrome (GS) is the most common inherited renal tubular disease, while diabetes is one of the most prevalent diseases in the world. Recently, some studies have found that GS patients had higher diabetic morbidity. However, the coexistence of these three diseases has yet to be reported.
CASE SUMMARY
We report the case of a 62-year-old Chinese man who was admitted with weakness in the extremities, muscle pain, and dark-colored urine. He had consumed liquorice water daily for seven days prior to admission. The laboratory tests revealed a serum potassium level of 1.84 mmol/L, magnesium 0.68 mmol/L, creatinine phosphokinase (CK) 10117 IU/L, and marked hemoglobinuria. Fractional chloride excretion and fractional magnesium excretion were increased. Plasma renin activity and aldosterone concentration were within the normal ranges. Sequence analysis of the SLC12A3 gene revealed that he had compound heterozygous mutations. The diagnosis of liquorice-induced severe hypokalemic rhabdomyolysis with GS and diabetes was thus genetically confirmed. Serum potassium and CK quickly improved with potassium replacement therapy, hydration, and discontinuation of liquorice ingestion. Upon follow-up at 3 mo, the levels of CK, myoglobin, and potassium remained normal, and magnesium was above 0.6 mmol/L.
CONCLUSION
This case emphasizes that liquorice consumption and GS should be considered causes of hypokalemia and that the diabetic status of GS patients should be noted in the clinic.
