[Severe hypokalemia after holidays return]

A 52-year old man is referred to our institution for hypertension (190/90 mmHg) and lower limb edema. An initial blood sample reveals severe hypokalemia (1.58 mEq/l) associated with metabolic alkalosis (pH: 7.63; total bicarbonates: 47.7 mEq/I), rhabdomyolysis (CPK: 1.776 UI/I) and ECG modifications. Primary aldosteronism is suspected and further diagnostic procedures are performed. A urine sample shows inappropriate potassium elimination associated with both low plasmatic renin and aldosterone levels, orienting the diagnosis toward a case of pseudohyperaldosteronism. A more detailed history reveals daily consumption of more than half a liter of licorice-based aperitif during the holiday period. This case illustrates the paramount importance of a detective-like questioning and reminds the physiopathologic role of glycyrrhetinic acid as a cause of hyperaldosteronism.