An unusual cause of hypokalemic muscle weakness

A 36-year-old woman presented with proximal muscle weakness, cramps, and a serum potassium level of 2.7 mEq/l. During her hospitalization she was noted to use excessive quantities of a snuff preparation containing glycyrrhizinic acid, a potent mineralocorticoid analogue. With discontinuation of this substance, her potassium returned to normal values and her strength improved. This case is submitted as a hypokalemia myopathy induced by snuff dipping.