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

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.