From the Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN.
J Addict Med. 2024;18(5):599-601. doi: 10.1097/ADM.0000000000001314. Epub 2024 May 31.
Kava consumption is a traditional practice in Polynesian and Micronesian cultures. It has recently gained popularity in the United States for therapeutic and recreational use. We report the following case. A man presented to the emergency department after a fall while intoxicated on kava. He was medically admitted for altered mental status, facial and clavicle fractures, and hyponatremia. Psychiatry was consulted for management of delirium. On interview, he reported consuming escalating amounts of kava for weeks despite attempts to stop. He was diagnosed with acute kava withdrawal with hyperactive delirium, treated with phenobarbital load (860 mg) and taper (390 mg). Continuous dexmedetomidine drip to hospital day 3 treated sympathetic activation and breakthrough agitation. By day 4, his delirium resolved and remained in remission until discharge. We performed a systematic review for reports of kava withdrawal, returning 9 studies. Eight assessed withdrawal symptoms after cessation of a low controlled dose of kava extract with no symptoms noted. One reported a case series of heavy kava users with seizure-like events. No publications discussed treatment of kava withdrawal. To our knowledge, this is the first publication to describe kava withdrawal syndrome and its effective treatment with phenobarbital.
卡瓦（胡椒科植物）消费是波利尼西亚和密克罗尼西亚文化中的一种传统做法。最近，它在美国因其治疗和娱乐用途而变得流行。我们报告以下病例。一名男子在醉酒后跌倒，出现精神状态改变、面部和锁骨骨折和低钠血症，到急诊室就诊。因谵妄而行精神病学会诊以进行治疗。在访谈中，他报告说尽管试图停止，但数周来一直在过量摄入卡瓦。他被诊断为急性卡瓦戒断伴活跃性谵妄，给予苯巴比妥负荷量（860 毫克）和减量（390 毫克）。连续给予右美托咪定滴注至入院第 3 天，以治疗交感神经激活和突破性激越。到第 4 天，他的谵妄得到缓解，直到出院仍未再发。我们对卡瓦戒断的报告进行了系统回顾，共返回 9 项研究。其中 8 项研究评估了低剂量卡瓦提取物停药后的戒断症状，未发现症状。其中一项报告了一项大量卡瓦使用者的病例系列，出现类似癫痫发作的事件。没有出版物讨论卡瓦戒断的治疗。据我们所知，这是第一篇描述卡瓦戒断综合征及其用苯巴比妥有效治疗的出版物。
