Singh Vir, Mulla Nadir, Wilson James Link, Umansky Aaron, Lee Jenny, Stead Trilok, Ganti Latha
University of Central Florida College of Medicine, Ocala Regional Medical Center, Ocala, FL, USA.
Envision Physician Services, Clearwater, FL, USA.
Int J Emerg Med. 2020 Aug 5;13(1):42. doi: 10.1186/s12245-020-00301-0.
Kratom is a habit-forming opioid-like substance with an acute toxidrome of various symptoms such as diaphoresis, dizziness, nausea, and vomiting. Chronic users require increasing dosages for the analgesic effects. Although kratom use dates back to the 1800s in Asia, kratom intoxication is still a novel (but increasing) toxidrome in the Western world. Here, we present a novel case of acute toxicity from overdose in a kratom-naïve patient, taking place through recommendation by a family member who chronically takes this substance.
We present the case of a 62-year-old woman arriving to the emergency department (ED) with a chief complaint of intractable vomiting after ingestion of kratom. After a day of yard work, she was in pain, secondary to her osteoporotic joints. She was recommended kratom from a family member, who stated he was using kratom to transition away from opioid dependence. She took two "scoops." She proceeded to have multiple episodes of vomiting at home. She came to the ED, where she required multiple rounds of anti-emetic medication for resolution of her symptoms.
We present a classic case of a novel acute toxicity: kratom. A unique aspect of this case is the circumstance by which this toxicity took place: a family member who chronically takes this substance (that requires increasing dosages to remain effective) recommended a dosage to this kratom-naïve patient, leading to overdose. This opioid family alternative substance is gaining popularity across the USA in the era of the opioid crisis. Further documentation of case reports and research is required to learn the associated risks of the use of this substance.
kratom是一种会使人上瘾的阿片类物质，会引发诸如发汗、头晕、恶心和呕吐等各种症状的急性中毒综合征。慢性使用者需要不断增加剂量才能获得镇痛效果。尽管kratom在亚洲的使用可追溯到19世纪，但kratom中毒在西方世界仍是一种新出现（但呈上升趋势）的中毒综合征。在此，我们报告一例首次接触kratom的患者因过量服用导致急性中毒的新病例，该患者是在长期服用这种物质的家庭成员的推荐下服用的。
我们报告一例62岁女性患者，因服用kratom后出现顽固性呕吐为主诉前来急诊科就诊。在进行了一天的庭院劳作后，她因骨质疏松性关节疼痛。一名家庭成员向她推荐了kratom，称自己正在使用kratom来戒除阿片类药物依赖。她服用了两勺。随后她在家中多次呕吐。她来到急诊科，在这里她需要多次使用止吐药物才能缓解症状。
我们报告了一例新型急性中毒——kratom中毒的典型病例。该病例的一个独特之处在于中毒发生的情况：一名长期服用这种物质（需要不断增加剂量才能保持药效）的家庭成员向这名首次接触kratom的患者推荐了一个剂量，导致过量服用。在阿片类药物危机的时代，这种阿片类家族替代物质在美国越来越受欢迎。需要进一步记录病例报告和开展研究，以了解使用这种物质的相关风险。
