Department of Emergency Medicine, University of California, San Francisco, San Francisco, California.
Department of Pediatrics, Cincinnati Children's Hospital, Cincinnati, Ohio; Drug and Poison Information Center, Cincinnati, Ohio.
J Emerg Med. 2022 Jul;63(1):e28-e30. doi: 10.1016/j.jemermed.2022.02.004. Epub 2022 Aug 6.
Kratom (Mitragyna speciosa), an evergreen tree native to Southeast Asia, contains alkaloids that cause both stimulant and opioid-like effects. In the United States, its use continues to grow. Kratom products, however, are unregulated and nonstandardized, and reports of adulteration have been described previously.
A 21-year-old African-American woman with a history of occasional headaches and self-treatment with internet-purchased kratom presented to the emergency department with the chief symptoms of nausea, vomiting, and left flank pain. Laboratory tests showed a markedly elevated serum creatinine of 4.25 mg/dL (reference range 0.6-1.2 mg/dL) and proteinuria. A computed tomography scan of the abdomen and pelvis was unrevealing. A standard urine screen for drugs of abuse was positive for opiates. A confirmatory testing revealed the presence of hydrocodone and morphine in the urine. Hydrocodone, morphine, and mitragynine were identified in a sample of kratom leaves provided by the patient. The patient's renal function improved with supportive care and normalized 1 month post discharge after kratom discontinuation. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Despite widespread use, relatively little is known about kratom's adverse effects, particularly regarding its potential to cause renal insufficiency. This case illustrates the vital importance of recognizing that adulteration of unregulated products is certainly a possibility and clinicians may continue to see a rise in adverse effects, given kratom's increasing popularity.
Kratom（Mitragyna speciosa），一种原产于东南亚的常绿乔木，含有既具有兴奋剂作用又有类鸦片效果的生物碱。在美国，它的使用在持续增长。然而，Kratom 产品不受监管且没有标准化，先前已有掺假的报道。
一名 21 岁的非裔美国女性，偶尔有头痛，自行购买互联网上售卖的 Kratom 进行治疗，因恶心、呕吐和左侧腰痛就诊于急诊。实验室检查显示血清肌酐显著升高至 4.25mg/dL（参考范围 0.6-1.2mg/dL）和蛋白尿。腹部和骨盆的计算机断层扫描（CT）无明显异常。标准尿液药物滥用筛查呈阿片类药物阳性。确认检测显示尿液中含有氢可酮和吗啡。在患者提供的一片 Kratom 叶子样本中发现了氢可酮、吗啡和 mitragynine。在停用 Kratom 后 1 个月，患者的肾功能在支持性治疗下改善并恢复正常。
为什么急诊医生应该了解这个问题？：尽管广泛使用，但人们对 Kratom 的不良反应知之甚少，特别是它可能导致肾功能不全的问题。这个病例说明了认识到不受监管的产品掺假的可能性非常重要，鉴于 Kratom 的日益普及，临床医生可能会继续看到更多的不良反应。
