Potassium chloride supplementation improved serum potassium from 1.44 to 2.93 mEq/L and recovered muscle strength from MMT 2/5 to 4/5 in left extremities over 15 days in a 75-year-old woman with hypokalemic myopathy caused by Ryokeijutsukanto.
Case Report (n=1)
No
75-year-old woman presenting with low back pain and left upper and lower limb muscle weakness (hemiparesis) mimicking a stroke, with a history of lumbar spinal stenosis, old cerebral infarctions, and lumbar compression fracture.
Ryokeijutsukanto kampo herbal medicine (containing Chinese licorice/glycyrrhetinic acid) 7.5 g/day
Chinese licorice-containing kampo medicines can cause pseudo-aldosteronism leading to severe hypokalemic myopathy, which may present atypically as hemiparesis mimicking a stroke.
The patient was a 75-year-old woman who developed hypokalemia-induced myopathy of the left upper and lower extremities after she had started taking Ryokeijutsukanto kampo herbal medicine. She visited our hospital’s orthopedic surgery department with a 2-day history of low back pain and difficulty in moving her left leg. No signs of muscle weakness were observed, so the patient was prescribed a back brace and sent home. However, since the weakness in the left leg and arm was persistent, she was transported by ambulance again to our hospital during the night. Cranial MRI was normal. Blood tests showed significant hypokalemia (K 1.44 mEq/L) and an elevated serum level of creatine phosphokinase (CPK), and the patient was started on intravenous potassium replacement. The paresis improved with the potassium supplementation and the patient was discharged on Day 17, after she exhibited independent ambulation. A review of the medications she was taking at admission revealed that the patient had been taking an oral kampo herbal medicine containing Chinese licorice (Ryokeijutsukanto), and this was suspected as the cause of the hypokalemia.
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Yoshikazu Takinami
Daisuke Yagi
Fukui Red Cross Hospital
Nihon Gekakei Rengo Gakkaishi (Journal of Japanese College of Surgeons)
Sapporo Kosei General Hospital
University of Fukui Hospital
Fukui Red Cross Hospital
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Takinami et al. (Wed,) conducted a case report in 75-year-old woman with hypokalemia-induced myopathy presenting as left upper and lower limb muscle weakness after taking Ryokeijutsukanto kampo herbal medicine (n=1). Intravenous and oral potassium chloride supplementation was evaluated on Improvement of muscle strength and serum potassium levels (recovery from hypokalemia-induced myopathy). Potassium chloride supplementation improved serum potassium from 1.44 to 2.93 mEq/L and recovered muscle strength from MMT 2/5 to 4/5 in left extremities over 15 days in a 75-year-old woman with hypokalemic myopathy caused by Ryokeijutsukanto.
synapsesocial.com/papers/69a528ecf1e85e5c73bf062d — DOI: https://doi.org/10.4030/jjcs.50.70
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