Abstract
Yokukansan is a Chinese herbal medicine containing licorice that has been shown to alleviate the behavioral and psychological symptoms of Alzheimer's disease, with few adverse effects. Increasing numbers of patients with Alzheimer's disease in Japan are now being treated with this drug. However, yokukansan should be used with caution because of its potential to induce pseudoaldosteronism through the inhibition of 11-beta-hydroxysteroid dehydrogenase type 2, which metabolizes cortisol into cortisone. We present the case of an 88-year-old woman with a history of Alzheimer's disease who was transferred to our emergency department because of drowsiness, anorexia, and muscle weakness. Her blood pressure was 168/90 mmHg. Laboratory data showed serum potassium of 1.9 mmol/l, metabolic alkalosis (pH 7.54; HCO 3(-) , 50.5 mmol/l; chloride, 81 mmol/l; sodium, 140 mmol/l), and respiratory disorders (pCO2, 60.5 mmHg; pO2, 63.8 mmHg). Plasma renin activity and aldosterone concentration were suppressed, and urinary potassium excretion was 22 mmol/l (calculated transtubular potassium gradient 12.9). An electrocardiogram showed flat T-waves and U-waves with ventricular premature contractions. Echocardiography denied volume depletion. Medical i...Continue Reading
References
Nov 3, 1991·The New England Journal of Medicine·R V FareseR Gomez-Fontes
Oct 10, 1987·Lancet·P M StewartC R Edwards
Jul 17, 1987·Science·J L ArrizaR M Evans
Apr 1, 1983·Endocrinologia Japonica·Y FujiwaraY Shigeta
Oct 1, 1994·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·K S KamelM L Halperin
Dec 26, 2001·Hypertension·P FerrariF J Frey
Feb 8, 2003·Journal of Human Hypertension·H A SigurjonsdottirS Wallerstedt
Oct 20, 2005·JAMA : the Journal of the American Medical Association·Lon S SchneiderPhilip Insel
Oct 4, 2006·Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan·Masato HommaYukinao Kohda
May 3, 2007·Internal Medicine·Hirofumi YasueEisaku Harada
Jun 23, 2007·Current Medicinal Chemistry·Shih-Hua Lin, Mitchell L Halperin
Dec 17, 2008·The International Journal of Neuropsychopharmacology·Katsuyoshi MizukamiKenji Toba
Jan 20, 2009·Current Drug Safety·Chaker Ben SalemKamel Bouraoui
Feb 23, 2010·Progress in Neuro-psychopharmacology & Biological Psychiatry·Kazunori OkaharaYoshio Mitsuyama
Feb 27, 2010·Progress in Neuro-psychopharmacology & Biological Psychiatry·Yoshihito HayashiYoshio Mitsuyama
May 26, 2010·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Prajwol PantJen Chieh Cheng
Jul 9, 2010·Advances in Chronic Kidney Disease·Lynn E SchlangerJeff M Sands
May 17, 2011·Journal of the American Geriatrics Society·Koh IwasakiToru Kinoshita