Tobacco Chewer's Hypokalemia: Licorice Revisited

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Abstract
THE syndrome of pseudo-primary hyperaldosteronism is a well-known complication of chronic, excessive licorice ingestion.1 Natural licorice, an extract of Glycyrrhiza glabra root, contains glycyrrhizinic acid, a compound with well-documented mineralocorticoid activity.2 Pseudo-primary hyperaldosteronism is rarely reported in the United States, since artificial licorice flavoring is used in commercial products. Certain chewing tobaccos contain large amounts of true licorice, and thus have the potential to produce pseudohyperaldosteronism.Case ReportAn 85-year-old man had had both progressive, generalized weakness and an inability to rise from a sitting position for 10 days. He reported no sensory disturbances, use of drugs, loss of consciousness, . . .