Abstract
We describe a patient who suffered from intracerebral hemorrhage and pseudoaldosteronism caused by the use of glycyrrhizic acid and Yi-Gan San (Yokukan-San in Japanese). An 85-year-old woman with hepatic dysfunction and dementia, who had taken glycyrrhizic acid and Yi-Gan San for more than 6 months, was admitted to our hospital complaining anorexia and aggravation of dementia. Neurological examination revealed loss of muscle strength and left hemianopsia. Brain computed tomography demonstrated subcortical hemorrhage in the right occipital lobe. Additionally, pseudoaldosteronism was diagnosed based on blood test and electrocardiogram. Glycyrrhizic acid and Yi-Gan San was stopped immediately and conservative treatment was initiated. During several subsequent days in the hospital the drug-resistant elevation of blood pressure was noted, however it decreased gradually in parallel with normalization of the serum potassium level. Since glycyrrhiza is one of the components of Yi-Gan San, it can induce drug-resistant secondary hypertension. Therefore, patients who use Yi-Gan San as a part of combination therapy with other drugs, such as glycyrrhizic acid, require special attention. To prevent the possible complications such as the brain hemorrhage, we need regularly to examine the blood test, electrocardiography and to maintain blood pressure.
