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Abstract
Kratom exposures presenting to the emergency department are likely to increase due to the nationwide opioid crisis.[...]the aim of this study is to summarize the clinical effects of kratom in a series of cases reported to our regional poison center.Median presenting vital signs included: heart rate of 102bpm, blood pressure 151/89mm Hg, respiratory rate 20rpm, pulse oximetry of 99% and temperature 37°C. Electrocardiograms obtained on three patients had a median QRS of 114ms and QTc of 476ms, and no dysrhythmias were described.Patient number Age Summary of clinical effects 1 60year Therapeutic us of kratom for analgesia Stopped prescribed lupus medications and started kratom, one teaspoon TID for one month Discovered to have elevated transaminases and bilirubin Gastroenterology service found no other etiologies Treated with 21h of n-acetylcysteine and transaminases improved 2 1day Neonatal abstinence syndrome Neonate born from a mother using kratom during pregnancy Pt. subsequently developed diarrhea and tachypnea Diagnosed neonatal opioid abstinence syndrome by neonatologist Treated with a combination of benzodiazepines, morphine and intravenous rehydration Drug testing results of the mother and neonate are unknown Treatment with morphine sulfate and benzodiazepines 3 45year Athletic performance enhancement Intermittently ingested kratom for the past ten months In preparation for a cycling race, took extra kratom Had a generalized seizure and developed mild rhabdomyolysis Negative urine drug screen and no abnormalities of electrolytes Head CT with nasal bone fracture and soft tissue hematoma 1 E. Cinosi, G. Martinotti, P. Simonato, D. Singh, Z. Demetrovics, A. Roman-Urrestarazu, Mitragyna speciosa, ): the evolution of an enhancer from a traditional use to increase work and productivity in Southeast Asia to a recreational psychoactive drug in western countries, Biomed Res Int, Vol. 2015, 2015, 968786 2 M.L. Warner, N.C. Kaufman, O. Grundmann, The pharmacology and toxicology of kratom: from traditional herb to drug of abuse, Int J Leg Med, Vol. 130, 2016, 127-138 3 R. Voelker, Kratom products seized, JAMA, Vol. 316, 2016, 1142 4 D. Singh, S. Narayanan, B. Vicknasingam, Traditional and non-traditional uses of mitragynine (kratom): a survey of the literature, Brain Res Bull, Vol. 126, 2016, 41-46 5 M.T. Swogger, E. Hart, F. Erowid, E. Erowid, N. Trabold, K. Yee, Experiences of kratom users: a qualitative analysis, J Psychoactive Drugs, Vol. 47, 2015, 360-367 6 K.M. Babu, C.R. McCurdy, E.W. Boyer, Salvia divinorum, and kratom, Clin Toxicol (Phila), Vol. 46, 2008, 146-152 7 M. Anwar, R. Law, J. Schier, Mitragyna speciosa, ) exposures reported to poison centers - United States, 2010-2015, MMWR Morb Mortal Wkly Rep, Vol. 65, 2016, 748-749 8 M.B. Forrester, Kratom exposures reported to Texas poison centers, J Addict Dis, Vol. 32, 2013, 396-400 9 S. Trakulsrichai, A. Tongpo, C. Sriapha, S. Wongvisawakorn, P. Rittilert, S. Kaojarern, Kratom abuse in Ramathibodi poison center, Thailand: a five-year experience, J Psychoactive Drugs, Vol. 45, 2013, 404-408 10 F. Pantano, R. Tittarelli, G. Mannocchi, S. Zaami, S. Ricci, R. Giorgetti, Hepatotoxicity induced by “the 3Ks”: kava, kratom and khat, Int J Mol Sci, Vol. 17, 2016, 580 11 C. Dorman, M. Wong, A. Khan, Cholestatic hepatitis from prolonged kratom use: a case report, Hepatology, Vol. 61, 2015, 1086-1087 12 F.G. Kapp, H.H. Maurer, V. Auwarter, M. Winkelmann, M. Hermanns-Clausen, Mitragyna speciosa, ), J Med Toxicol, Vol. 7, 2011, 227-231 13 S. Guddat, C. Gorgens, V. Steinhart, W. Schanzer, M. Thevis, Mitragynine (kratom) - monitoring in sports drug testing, Drug Test Anal, 2016 14 D. Singh, C.P. Muller, B.K. Vicknasingam, S.M. Mansor, Mitragyna speciosa, ) users in Malaysia, J Psychoactive Drugs, Vol. 47, 2015, 125-131