Kratom toxicity

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 symptoms, 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

Opioid overdose Opioid withdrawal Sympathomimetic overdose

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