Behçet AL, Mustafa BOĞAN, Demet ARI YILMAZ, Yılmaz SAFİ, Cuma YILDIRIM, Suat ZENGİN, Mehmet Murat OKTAY

Dönemsel bir akciğer ödemi nedeni: Meyan şerbeti içimi

Bu çalışmanın amacı dönemsel meyan kökü şerbeti tüketimine bağlı gelişen akciğer ödemli hastaları değerlendirmektir. 2011 ve 2012 Ramazan döneminde nefes darlığı ile acil servise başvuran ve son günlerde meyan şurubu tüketen tüm hastalar detaylı olarak muayene edildi. Hastaların rutin biyokimyasal tetkikleri yapıldı, akciğer grafisi ve elektrokardiyografileri çekildi. Ayrıca hastaların kardiyak fonksiyonlarına ekokardiyografi ile bakıldı. İntertisyel akciğer ödemi tespit edilen hastalara ait dosya bilgileri kaydedildi ve tüm bu veriler incelendi. İki aylık dönemde (2011 ve 2012 Ramazan dönemi) akciğer ödemi tanısı konulan hasta sayısı 82 idi. Bu hastaların 32 sinde (%39) meyan şerbeti tüketimi hikâyesi vardı. İlk değerlendirmede hastaların ortalama sistolik kan basıncı 160,5±18,3 mmHg (130-220), diastolik kan basıncı 92,6±9,8 mmHg (75-120) olarak ölçüldü. Hastaların ortalama sodyumu: 143,2±3,47 mmol/L (134- 149), potasyumu: 3,4±0,3 mmol/L (3,1-4,3), üre: 56,1±18,9 mg/dl (26-114), kreatinin: 1,1±0,27 mg/dl (0,6-1,8) idi. On iki hastanın ejeksiyon fraksiyonu %40ın altında tespit edildi. Hastaların 19u koroner yoğun bakıma yatırılıp tedavi edilirken, 13ü acil serviste tedavi edildi. Tüm hastalar şifa ile taburcu oldu. Meyan şerbeti tüketimi, akciğer ödemi ve/veya hipertansiyonun gizli kalan bir nedenidir. Bu sebeple akciğer ödemi ve/veya hipertansiyon tanısı alan hastalarda meyan şerbeti tüketimi mutlaka sorgulanmalıdır.

A cause of a periodic pulmonary edema: Consumption of licorice syrup

The aim of this study is to evaluate patients with pulmonary edema due to periodical consumption of licorice syrup. The patients who consumed licoric syrup in recently and admitted to emergency department with dyspnea were examined comprehensive during Ramadan in 2011 and 2012. They underwent routine biochemical investigations, chest X-rays, and electrocardiogram assessment. In addition, cardiac function was examined using echocardiography. Information relating to patients detected with interstitial pulmonary edema was recorded, and all recorded data were evaluated. The number of patients diagnosed with pulmonary edema in the 2-month period was 82. Thirty two of these patients (39%) had a history of consumption of licorice syrup. At first assessment, the mean systolic blood pressure of the study participants was 160.5±18.3 mmHg (130-220), and diastolic blood pressure was 92.6 ±9.8 mmHg (75- 120). The mean sodium level was 143.2±3.47 mmol/L (134-149), potassium was 3.4±0.3 mmol/L (3,1-4,3), urea was 56.1±18.9 mg/dl (26-114), and creatinine was 1.1±0.27 mg/dL (0,6-1,8). The injection fraction of 12 patients was under 40%. Of the study participants, 19 were hospitalized in a coronary intensive care unit, while 13 were treated with an emergency department. All study participants recovered and were subsequently discharged from hospital. Excessive consumption of licorice syrup is a hidden cause of pulmonary edema and/or hypertension and therefore should be investigated for in individuals diagnosed with these conditions.

PDF

___

1. Omar HR, Komarova I, El-Ghonemi M, Fathy A, Rashad R, Abdelmalak HD, et al. Licorice abuse: time to send a warning message. Ther Adv Endocrinol Metab 2012;3(4):125-38.
2. Imtıaz K.E. Sweet root, bitter pill: liquorice-induced hyperaldosteronism QJM 2011;104(12):10935
3. Hamidon BB, Jeyabalan V. Exogenously-induced apparent hypermineralocorticoidism associated with ingestion of asam boi. Singapore Med J 2006;47(2):156-8.
4. Farese RV Jr, Biglieri EG, Shakelton CH, Irony I, Gomez- Fontes R. Licorice-induced hypermineralocorticoidism. N Engl J Med 1991;325(17):1223-7.
5. Hasegawa J, Suyama Y, Kinugawa T, Morisawa T, Kishimoto Y. Echocardiographic findings of the heart resembling dilated cardiomyopathy during hypokalemic myopathy due to licorice- induced pseudoaldosteronism. Cardiovasc Drugs Ther 1998;12(6):599600.
6. Chamberlain TJ. Licorice poisoning, pseudoaldosteronism, and heart failure. JAMA 1970;213(8):1343.
7. Chamberlain JJ, Abolnik IZ. Pulmonary edema following a licorice binge. West J Med 1997;167(3):184-5.
8. Meltem AC, Figen C, Nalan MA, Mahir K, Sebnem B, Mehlika I, et al. A hypokalemic muscular weakness after licorice ingestion: a case report. Cases J 2009;2:8053.
9. Yasue H, Itoh T, Mizuno Y, Harada E. Severe hypokalemia, rhabdomyolysis, muscle paralysis, and respiratory impairment in a hypertensive patient taking herbal medicines containing licorice. Intern Med 2007;46(9):575-8.
10. van den Bosch AE, van der Klooster JM, Zuidgeest DM, Ouwendijk RJ, Dees A. Severe hypokalaemic paralysis and rhabdomyolysis due to ingestion of licorice. Neth J Med 2005;63(4):1468.
11. Lin SH, Yang SS, Chau T, Halperin ML. An unusual cause of hypokalemic paralysis: chronic licorice ingestion. Am J Med Sci 2003;325(3):153-6.
12. Elinav E, Chajek-Shaul T. Licorice consumption causing severe hypokalemic paralysis. Mayo Clin Proc 2003;78(6):7678.
13. Russo S, Mastropasqua M, Mosetti MA, Persegani C, Paggi A. Low doses of liquorice can induce hypertension encephalopathy. Am J Nephrol 2000;20(2):1458.
14. Yorgun H, Aksoy H, Sendur MA, Ates AH, Kaya EB, Aytemir K, et al. Brugada syndrome with aborted sudden cardiac death related to liquorice-induced hypokalemia. Med Princ Pract 2010;19(6):4859.
15. Ruiz-Granados ES, Shouls G, Sainsbury C, Antonios T. A salty cause of severe hypertension. BMJ Case Rep. 2012 Feb 25;2012.
16. Asl MN, Hosseinzadeh H. Review of pharmacological effects of glycyrrhiza sp. and its bioactive compounds. Phytother Res 2008;22(6):709-24.