Dying for a cup of tea

Area of Science:

• Cardiology
• Clinical Toxicology
• Pharmacovigilance

Background:

• Liquorice consumption is associated with potential health risks, including hypertension.
• Regulatory warnings often focus on hypertension, potentially overlooking other adverse effects.
• Herb-based products require thorough safety assessments for all potential toxicities.

Observation:

• A 70-year-old woman presented with acute, severe hypokalaemia.
• The hypokalaemia was directly linked to the excessive consumption of liquorice-rich herb tea.
• The patient experienced life-threatening cardiac arrhythmia as a consequence of low potassium levels.

Findings:

• Acute and severe hypokalaemia can precipitate serious cardiac arrhythmias.
• Liquorice, even in herbal tea form, can induce profound electrolyte disturbances.
• The severity of hypokalaemia and subsequent arrhythmia was notable, occurring in a patient with no prior cardiac history.

Implications:

• There is a critical need to update consumer warnings regarding liquorice-containing products to include the risk of hypokalaemia and cardiac arrhythmias.
• Regulatory bodies in the USA and Europe should address the discrepancy in warnings, ensuring comprehensive risk communication.
• Healthcare providers should inquire about herbal tea consumption in patients presenting with unexplained electrolyte imbalances or arrhythmias.