Severe hypokalemic rhabdomyolysis due to ingestion of liquorice during Ramadan

Abstract

A 62-year-old man was admitted with severe hypokalemia following ingestion of a modest amount of liquorice during the Islamic holy month of Ramadan. Hypokalemia was associated with typical electrocardiographic changes, marked acid-base disturbance and complicated by rhabdomyolysis. All abnormalities improved with normalisation of serum potassium. The serum creatine kinase isoenzymes (CK-total and MB) returned to normal over a prolonged period. The potential danger of ingesting liquorice even in small amounts over short periods, and the role of concomitant diuretic therapy with the additional factor of fasting during Ramadan in precipitating hypokalemia during liquorice ingestion are discussed.