Kratom toxicity: Difference between revisions
Spenceemmett (talk | contribs) (Created page with "==Background== *Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia *Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA recepto...") |
|||
| (13 intermediate revisions by 4 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
[[File:Kratom leaves.jpg|thumb|Kratom flowers and foliage.]] | |||
[[File:Powdered kratom.jpg|thumb|Typical powdered Kratom for commercial use.]] | |||
*Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia | *Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia | ||
*Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors | *Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors | ||
*Increasingly popular in | *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== | ==Clinical Features== | ||
*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== | ||
[[Opioid overdose]] | *[[Opioid overdose]] | ||
[[Opioid withdrawal]] | *[[Opioid withdrawal]] | ||
[[Sympathomimetic overdose]] | *[[Sympathomimetic overdose]] | ||
*[[Anticholinergic toxicity]] | |||
{{Drugs of abuse types}} | |||
==Evaluation== | ==Evaluation== | ||
*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 | ||
*Consider [[EKG]] | |||
**Some patients may present with tachycardia and there is theoretical possibility [[QT prolongation]] | |||
==Management== | ==Management== | ||
*Management should be tailored to primary symptoms | *Management should be tailored to primary symptoms | ||
**Naloxone for respiratory depression | **[[Naloxone]] for respiratory depression | ||
**Benzodiazepines for hyperarousal, tachycardia, hypertension, and seizures | **[[Benzodiazepines]] for hyperarousal, tachycardia, hypertension, and seizures | ||
**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== | ||
*[[Opioids]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
<references/> | <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. | |||
[[Category:Toxicology]] | |||
Latest revision as of 18:03, 7 September 2022
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
Drugs of abuse
- 25C-NBOMe
- Alcohol
- Amphetamines
- Bath salts
- Cocaine
- Difluoroethane
- Ecstasy
- Gamma hydroxybutyrate (GHB)
- Heroin
- Inhalant abuse
- Hydrocarbon toxicity
- Difluoroethane (electronics duster)
- Marijuana
- Kratom
- Phencyclidine (PCP)
- Psilocybin ("magic mushrooms")
- Synthetic cannabinoids
- Chloral hydrate
- Body packing
Evaluation
- Clinical diagnosis
- Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis
- Consider EKG
- Some patients may present with tachycardia and there is theoretical possibility QT prolongation
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.