Liquorice is a well-known cause of secondary hypertension and hypokalaemia. Diuretic therapy is the most common cause of potassium deficiency. Liquorice ingestion along with thiazide therapy can cause refractory hypokalaemia. Nevertheless its presentation as severe hypokalaemia and paralysis is exceedingly rare.

A 46-year old hypertensive man, on Hydrochlochlorothiazide therapy for one-and- half years presented with acute onset flaccid quadriparesis. He was treated in the Critical Care Unit of NBMC. He had a history of consuming liquorice containing tea for one year. On examination, his blood pressure was 160/90 mm of Hg. Deep tendon reflexes were lost, plantar reflexes equivocal. Cranial nerve examination was normal and bladder involvement wasabsent.On 2ndday he developed respiratory distress (SpO2 75% in room air).He was found to have hypokalaemic metabolic alkalosis. Ventilatory support alongwith electrolyte monitoring and its titration was the mainstay of management in the subsequent days. Hypokalaemia was refractory due to accompanying hypomagnesaemia.Hypokalaemia persisted for ten days after stoppage of liquorice ingestion. There was recovery of muscle tone and power only after correction of hypokalaemia

Liquorice poisoning causes refractory hypokalaemia which may rarely lead to quadriparesis and respiratory failure. However, careful monitoring and critical care support can tide over such precarious condition and pave the path to recovery and health.