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Abstract: PO1116

Jägermeister-Induced Pseudohyperaldosteronism

Session Information

Category: Fluid, Electrolyte, and Acid-Base Disorders

  • 902 Fluid, Electrolyte, and Acid-Base Disorders: Clinical

Authors

  • Gotesman, Joseph Aaron, Lenox Hill Hospital, New York, New York, United States
  • Rosenstock, Jordan L., Lenox Hill Hospital, New York, New York, United States
Introduction

Hypertension and hypokalemia is known to be caused by hyperaldosteronism. We report a case of hypertension, hypokalemia, and supressed renin and aldosteronen levels. Dietary work-up revealed copius ingestion of Jagermeister liquor which contains licorice, a known cause of pseudohyperaldosteronism.

Case Description

A 54-year-old man with a history of HIV on Genvoya and CAD, HTN on metoprolol and isosorbide monoitrate was referred to nephrology for evaluation of hypokalemia and accelerated hypertension. Prior to nephrology referral, he was started on oral potassium for 6 weeks and the repeat potassium was 3.5 mmol/L. On review of systems, he had no specific complaints except occasional diarrhea. On exam, his BP was 190/110, 1+ lower extremity edema; his exam was otherwise unremarkable.

Initial workup revealed serum sodium 143 mmol/L, bicarb 24 mmol/L, potassium 3.5 mmol/L, creatinine 1.1 mg/dL, magnesium 1.5 mg/dL, urine K 78 mmol/L, FeK 13.6%, TSH 2.95 uIU/mL, plasma renin activity 1.191 ng/mL/hr, and aldosterone <3.0 ng/dL, and plasma metanephrines <10 pg/mL. Repeat K was 3.1, bicarb 30, plasma renin activity 0.195 ng/mL/hr, and aldosterone <3.0 ng/dL; urine K 34, FeK 11%; renal dopplers without evidence of RAS.

Given hypokalemia, metabolic alkalosis with evidence of potassium wasting, and suppressed renin and aldosterone levels, a thorough dietary review was conducted which revealed chronic Jagermeister ingestion of up to 500mL per day. He stopped drinking Jagermeister and on subsequent follow-up, his BP was controlled on amlodipine, carvedilol, and isosorbide mononitrate, and he no longer required potassium supplementation.

Discussion

Licorice contains glycyrrhizic acid which inhibits 11 beta-hydroxysteroid dehydrogenase, preventing inactivation of cortisol to cortisone, and resulting in excess mineralocorticoid activity manifested by suppressed renin and aldosterone levels, sodium retention, hypervolemia, hypokalemia, hypertension, and edema. According to the manufacturer, Jagermiester liquor contains under 10 mg/L of licorice, however, the amount that can cause toxicity is not certain and literature suggests that the glycyrrhizic acid content of licorice is widely variable. Physicians ought to consider dietary, non-medication causes for electrolyte abnormalities in patients with initial negative workups.