Kratom toxicity: Difference between revisions
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*Effects are dose dependent and may mimic those of both opioid and stimulant toxicity | *Effects are dose dependent and may mimic those of both opioid and stimulant toxicity | ||
*Stimulant effects typically predominate at low doses (<5 g) with sedating effects more prevalent at higher doses | *Stimulant effects typically predominate at low doses (<5 g) with sedating effects more prevalent at higher doses | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Clinical diagnosis | *Clinical diagnosis | ||
*Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis | *Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis | ||
==Management== | ==Management== | ||
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**NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms | **NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms | ||
***Medication-assisted treatment with buprenorphine or methadone | ***Medication-assisted treatment with buprenorphine or methadone | ||
==Disposition== | ==Disposition== | ||
*Discharge unless presenting with severe/intractable symptoms | *Discharge unless presenting with severe/intractable symptoms | ||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Revision as of 19:32, 27 June 2019
Background
- Derived from Mitragyna speciosa, a plant native to Southeast Asia
- Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors
- Increasingly popular in US for attempted self-treatment of pain, opioid addiction/withdrawal, and depression
- Patients often perceive incorrectly as a "safe" alternative to opioids
Clinical Features
- Effects are dose dependent and may mimic those of both opioid and stimulant toxicity
- Stimulant effects typically predominate at low doses (<5 g) with sedating effects more prevalent at higher doses
Differential Diagnosis
Evaluation
- Clinical diagnosis
- Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis
Management
- Management should be tailored to primary symptoms
- Naloxone for respiratory depression
- Benzodiazepines for hyperarousal, tachycardia, hypertension, and seizures
- NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms
- Medication-assisted treatment with buprenorphine or methadone
Disposition
- Discharge unless presenting with severe/intractable symptoms
See Also
External Links
References
- Swogger M, Walsh D. Kratom use and mental health: A systematic review. Drug and Alcohol Dependence. 2017;183:134-140.
- Vestal C. Kratom Concerns. State Legislatures Magazine. 2018; 44(4)
- Killelea E. Kratom: Why Did the FDA Declare the Herbal Supplement an Opiate? Rolling Stone Magazine. March 2018.
- Gottlieb, S. Statement from FDA Commissioner Scott Gottlieb, M.D., on new warning letters FDA is issuing to companies marketing kratom with unproven medical claims; and the agency’s ongoing concerns about kratom [press release]. Sep 11, 2018.