Liquorice Toxicity: A Comprehensive Narrative Review.

Area of Science:

• Endocrinology
• Toxicology
• Pharmacology

Background:

• Liquorice, historically valued for medicinal properties, is now primarily used as a flavoring agent.
• Continuous high intake of liquorice is a known cause of pseudo-hyperaldosteronism, resulting in hypertension and hypokalemia.
• Severe complications, including arrhythmias, paralysis, rhabdomyolysis, and coma, can arise from liquorice excess, alongside estrogenic-like activity.

Purpose of the Study:

• To review current knowledge on liquorice toxicity.
• To analyze case reports of complications arising from excessive liquorice intake.

Main Methods:

• A comprehensive literature review was conducted.
• 104 case reports in English and Italian from inception to June 2023 were analyzed.

Main Results:

• Hypertension and electrolyte imbalance (hypokalemia) are common features of liquorice toxicity.
• Contrary to some data, female sex and advanced age were not identified as risk factors.
• Detection of glycyrrhetinic acid in blood is rare; diagnosis relies heavily on patient history.

Conclusions:

• Liquorice toxicity, while not highly fatal, frequently necessitates hospitalization, posing a significant public health concern.
• Increased public awareness regarding the risks of excessive liquorice consumption is recommended.
• Regulatory authorities should promote awareness of liquorice's potentially dangerous effects.