14 NEWS
14 NEWS
14 FEBRUARY 2025 ausdoc . com . au
Lollies lead to all sorts of toxicity
Queensland doctors report on a case of licorice-induced hypokalaemia . |
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“ Clinical risk factors for pseudohyperaldosteronism in our patient was his older age and concomitant intake of a thiazide diuretic for hypertension ,” the doctors noted . |
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Rada Rouse SIX weeks of munching through a birthday
box of confectionery has landed a man in ICU with severe hypokalaemia , Australian doctors report .
The 71-year-old ’ s daughter had gifted him sweets , which he proceeded to consume at a rate of about 720mg of raw licorice a day , according to his treating doctors , from Townsville Hospital and Health Service in north Queensland .
This meant he was ingesting more than the safe level of the licorice metabolite glycyrrhizin to avoid pseudohyperaldosteronism , they wrote in Clinical Case Reports . The man had been referred to ED by his cardiologist because of low potassium just as he was being readied for a coronary angiogram for stable angina .
He had experienced intermittent palpitations over the previous month and had a history of ischaemic heart disease ;
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a coronary artery stent ; and treatment for sleep apnoea , hypertension and dyslipidaemia .
On admission , he had a serum potassium of 2.3mmol / L , which dropped to a low of 1.9mmol / L on day two , necessitating aggressive potassium replacement via catheter in
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the ICU , the doctors wrote . On day six of admission , he was moved to a ward and remained stable at 4.0mmol / L on oral potassium 1800mg qid .
He was discharged on day nine with no potassium supplementation and advice to stop eating licorice .
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The patient consumed the sweets at a rate of about 720mg of raw licorice a day .
They said the quantity of licorice consumed suggested he was getting a daily dose of between 14.1mg and 180mg of glycyrrhizin : the metabolite that can cause toxicity .
The WHO suggested an upper limit of 100mg of glycyrrhizin daily was unlikely to cause adverse effects in most adults , the team said .
The doctors said — given pseudohyperaldosteronism , including severe hypokalaemia , could be a life-threatening emergency — manufacturers of licorice food products should be required to specify daily consumption limits on their labels . Clin Case Rep 2025 ; 12 Jan .
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When an oncologist is diagnosed with cancer
Carmel Sparke RADIATION oncologist Dr Catherine Sue Hwang used to encourage patients facing chemotherapy to shave their heads as one way to “ regain control ” of their treatments .
She also wondered at the vanity of women who refused chemotherapy for fear of losing their hair .
Then she was diagnosed with breast cancer aged 46 .
She says undergoing a double mastectomy , chemotherapy , radiation and menopause helped her to realise where she had gone wrong with some of her patients .
“ I spent the past 15 years of my life as a practising radiation oncologist and considered myself a cancer expert — but there was only so much I could know as a spectator ,” the US doctor wrote in her essay on HuffPost .
“ By being on the arena floor and fighting this terrible disease as a patient , I have become a more effective doctor who does not lose focus of the patients ’ humanity while treating their disease .”
One of her first lessons was when a doctor gave her an 85 % chance of survival at 10 years , telling her “ that ’ s a good number ”.
Yet she was in shock at what that actually meant — a 15 % chance of developing metastatic disease and dying by 2035 .
“ The insensitivity of past comments I ’ ve made to patients became glaringly clear ,” wrote Dr Hwang , who specialises in breast cancer patients at the AdventHealth Cancer Institute in Orlando , Florida .
“ I would often tell women with low-risk breast cancer that their disease likely won ’ t kill them , and that if they didn ’ t do radiation at this time , they could do it in the future if the cancer came back because it would presumably be caught early with routine imaging .
‘ I now understand the motivation to be overtreated and leave nothing to chance .’
“ The last phrase stuck with me the most because I was doing routine imaging and my cancer was not caught early .
“ So I now understand the motivation to be overtreated and leave nothing to chance , despite what a physician may recommend .”
Her reaction to losing her hair also came as a surprise , as she clung to her last wisps despite previously encouraging her own patients to shave it off .
And she said she used to “ pass judgement ” on patients who chose less effective treatments than chemotherapy “ for not being able to prioritise their lives over their vanity ”.
“ However , as clumps of my own hair fell out , I learned just how much of my identity and self-worth were tied to my hair ,” she wrote .
“ As a physician , I encouraged patients to shave their head to regain control .
“ As a patient , I could never bring myself to actually do it .
“ So , the next time a patient asks for my opinion on the matter , I will give them my recommendation , but also tell them to do what feels right .”
As for weight issues and menopausal symptoms , Dr Hwang found it impossible to shift the 5kg she gained , despite following her own diet and exercise advice .
“ I now understood my patients ’ frustrations and felt extremely guilty for faulting them when they didn ’ t see results .”
She said it had been “ surreal ” to be treated by her own team , and parts of the experience were made more terrifying with her medical knowledge .
“ Having counselled thousands of patients through their breast cancer diagnosis , I was fully aware of how non-discriminatory this disease could be ,” Dr Hwang wrote .
“ But I always thought if I was ever diagnosed , it would be caught early because I underwent routine mammograms . “ I never expected to have high-volume , lymph-node-positive disease .”
When the final pathology revealed more extensive disease than initially anticipated , her medical oncologist , and a close friend ,
The back of Dr Hwang ’ s head at the end of chemotherapy .
COURTESY OF DR CATHERINE SUE HWANG
Dr Catherine Sue Hwang using a vein finder to help locate a vein for chemotherapy .
added chemotherapy , CDK4 / 6 inhibitors and hysterectomy and oophorectomy to her treatment plan .
“ I knew that radiation would be required after taking a quick glance at my chart ,” she said .
“ Knowledge is power , but it can also be terrifying . In that one moment , I imagined myself developing every major chemotherapy and radiation complication that my patients have experienced . “ I was overwhelmed and devastated .” While the past six months had been a “ blur ” of just trying to survive , while working and parenting , the experience had made her a better doctor .
“ Undergoing treatment for breast cancer has been a life-changing experience , but I have emerged stronger and more resilient and have found a renewed purpose and meaning in my chosen profession through my diagnosis .”
COURTESY OF DR CATHERINE SUE HWANG