Kratom toxicity - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:44Z

Strip excess bold

← Revisión anterior		Revisión del 09:30 22 mar 2026
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	*Derived from ''Mitragyna speciosa,'' a tropical evergreen tree in the coffee family native to Southeast Asia		*Derived from ''Mitragyna speciosa,'' a tropical evergreen tree in the coffee family native to Southeast Asia
	*Leaves contain over 40 alkaloids; the two most clinically relevant are:		*Leaves contain over 40 alkaloids; the two most clinically relevant are:
	**~~'''~~Mitragynine~~'''~~ (most abundant, up to 66% of total alkaloid content) — partial mu-opioid receptor agonist<ref name="kruegel">Kruegel AC, Grundmann O. The medicinal chemistry and neuropharmacology of kratom: A preliminary discussion of a promising medicinal plant and analysis of its potential for abuse. ''Neuropharmacology''. 2018;134(Pt A):108-120.</ref>		**Mitragynine (most abundant, up to 66% of total alkaloid content) — partial mu-opioid receptor agonist<ref name="kruegel">Kruegel AC, Grundmann O. The medicinal chemistry and neuropharmacology of kratom: A preliminary discussion of a promising medicinal plant and analysis of its potential for abuse. ''Neuropharmacology''. 2018;134(Pt A):108-120.</ref>
	**~~'''~~7-Hydroxymitragynine~~'''~~ (7-OH) (minor constituent, <2% of alkaloid content) — approximately 5-fold greater mu-opioid affinity than mitragynine<ref name="kruegel"/>		**7-Hydroxymitragynine (7-OH) (minor constituent, <2% of alkaloid content) — approximately 5-fold greater mu-opioid affinity than mitragynine<ref name="kruegel"/>
	*Both alkaloids exhibit G-protein biased agonism at mu-opioid receptors with limited beta-arrestin recruitment (theoretically less respiratory depression than classical opioids, though still reported)<ref name="kruegel"/>		*Both alkaloids exhibit G-protein biased agonism at mu-opioid receptors with limited beta-arrestin recruitment (theoretically less respiratory depression than classical opioids, though still reported)<ref name="kruegel"/>
	*Additional receptor activity at alpha-1A, alpha-2A, 5-HT1A, 5-HT2A, D1, and D2 receptors contributes to mixed stimulant-opioid clinical picture<ref name="yusof">Yusof SR, Zakaria Z, Amir Rawa MS, et al. Kratom Alkaloids: Interactions With Enzymes, Receptors, and Cellular Barriers. ''Front Pharmacol''. 2021;12:751656.</ref>		*Additional receptor activity at alpha-1A, alpha-2A, 5-HT1A, 5-HT2A, D1, and D2 receptors contributes to mixed stimulant-opioid clinical picture<ref name="yusof">Yusof SR, Zakaria Z, Amir Rawa MS, et al. Kratom Alkaloids: Interactions With Enzymes, Receptors, and Cellular Barriers. ''Front Pharmacol''. 2021;12:751656.</ref>
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	**May cause false-negative opioid screen despite opioid-like presentation		**May cause false-negative opioid screen despite opioid-like presentation
	**Specialized testing for mitragynine exists but is not widely available and generally not clinically useful in the acute setting		**Specialized testing for mitragynine exists but is not widely available and generally not clinically useful in the acute setting
	*Consider early consultation with ~~'''~~[[Poison control]]~~'''~~ (1-800-222-1222)		*Consider early consultation with [[Poison control]] (1-800-222-1222)

	===Labs===		===Labs===
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	==Management==		==Management==
	*Focus on ABCs and symptom-directed treatment		*Focus on ABCs and symptom-directed treatment
	*Consider early ~~'''~~[[Poison control]]~~'''~~ consultation (1-800-222-1222)		*Consider early [[Poison control]] consultation (1-800-222-1222)

	===Respiratory Depression===		===Respiratory Depression===
	*Supplemental oxygen, [[BVM]] ventilation as needed		*Supplemental oxygen, [[BVM]] ventilation as needed
	*~~'''~~[[Naloxone]]~~'''~~ — effective for kratom-induced respiratory depression due to mu-opioid agonism<ref name="greatimitator">Mikkelsen A, Van Roekel C, Grande EJ, et al. The Great Imitator: A Case of Accidental Kratom Overdose. ''Cureus''. 2023;15(7):e42497.</ref>		*[[Naloxone]] — effective for kratom-induced respiratory depression due to mu-opioid agonism<ref name="greatimitator">Mikkelsen A, Van Roekel C, Grande EJ, et al. The Great Imitator: A Case of Accidental Kratom Overdose. ''Cureus''. 2023;15(7):e42497.</ref>
	**Standard dosing as per [[opioid toxicity]] protocols		**Standard dosing as per [[opioid toxicity]] protocols
	**Be aware of potential for ~~'''~~rebound respiratory depression within 24 hours~~'''~~ per poison control center reports<ref name="greatimitator"/>		**Be aware of potential for rebound respiratory depression within 24 hours per poison control center reports<ref name="greatimitator"/>

	===Agitation / Sympathomimetic Features===		===Agitation / Sympathomimetic Features===
	*~~'''~~[[Benzodiazepines]]~~'''~~ for hyperarousal, agitation, [[tachycardia]], [[hypertension]], and [[seizures]]		*[[Benzodiazepines]] for hyperarousal, agitation, [[tachycardia]], [[hypertension]], and [[seizures]]
	*IV fluids		*IV fluids
	*Avoid [[haloperidol]] if concern for [[QT prolongation]]		*Avoid [[haloperidol]] if concern for [[QT prolongation]]

	===Seizures===		===Seizures===
	*~~'''~~[[Benzodiazepines]]~~'''~~ are first-line		*[[Benzodiazepines]] are first-line
	*Standard [[seizure]] management algorithm		*Standard [[seizure]] management algorithm

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	**[[Clonidine]] for autonomic symptoms		**[[Clonidine]] for autonomic symptoms
	**IV fluids for dehydration		**IV fluids for dehydration
	*~~'''~~Medication-assisted treatment~~'''~~ for opioid use disorder:		*Medication-assisted treatment for opioid use disorder:
	**~~'''~~[[Buprenorphine]]~~'''~~ — most commonly reported for kratom withdrawal/dependence; can be initiated in the ED per standard protocols<ref name="wapc"/>		**[[Buprenorphine]] — most commonly reported for kratom withdrawal/dependence; can be initiated in the ED per standard protocols<ref name="wapc"/>
	**~~'''~~[[Methadone]]~~'''~~ — alternative for patients not candidates for buprenorphine		**[[Methadone]] — alternative for patients not candidates for buprenorphine

	===Hepatotoxicity===		===Hepatotoxicity===
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	==Disposition==		==Disposition==
	*~~'''~~Discharge~~'''~~ if:		*Discharge if:
	**Mild symptoms (nausea, mild stimulant effects) that resolve with observation and supportive care		**Mild symptoms (nausea, mild stimulant effects) that resolve with observation and supportive care
	**Normal vital signs and mental status at time of disposition		**Normal vital signs and mental status at time of disposition
	**Able to tolerate PO		**Able to tolerate PO
	*~~'''~~Observation / Admission~~'''~~ if:		*Observation / Admission if:
	**Required naloxone for respiratory depression (observe ≥24 hours given risk of rebound respiratory depression)<ref name="greatimitator"/>		**Required naloxone for respiratory depression (observe ≥24 hours given risk of rebound respiratory depression)<ref name="greatimitator"/>
	**Persistent [[altered mental status]]		**Persistent [[altered mental status]]
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	**Hemodynamic instability		**Hemodynamic instability
	**Significant co-ingestion		**Significant co-ingestion
	*~~'''~~ICU admission~~'''~~ for:		*ICU admission for:
	**Respiratory failure / need for [[intubation]]		**Respiratory failure / need for [[intubation]]
	**Refractory [[seizures]]		**Refractory [[seizures]]

Ostermayer at 09:13, 5 March 2026

2026-03-05T09:13:42Z

Show changes

Rossdonaldson1: /* Evaluation */

2022-09-07T18:03:32Z

Evaluation

← Revisión anterior		Revisión del 18:03 7 sep 2022
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	==Evaluation==		==Evaluation==
	*Clinical diagnosis		*Clinical diagnosis
	*Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis		*Labs not routinely required unless severe [[vomiting]], [[seizure]], or unclear diagnosis
	*EKG ~~can be considered as some~~ patients may present with tachycardia and there is theoretical ~~evidence of~~ QT prolongation		*Consider [[EKG]]
			**Some patients may present with tachycardia and there is theoretical possibility [[QT prolongation]]

	==Management==		==Management==

Kfarzam: /* Evaluation */

2022-08-18T06:40:38Z

Evaluation

← Revisión anterior		Revisión del 06:40 18 ago 2022
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	*Clinical diagnosis		*Clinical diagnosis
	*Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis		*Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis
			*EKG can be considered as some patients may present with tachycardia and there is theoretical evidence of QT prolongation

	==Management==		==Management==

Rossdonaldson1 at 23:24, 17 August 2022

2022-08-17T23:24:07Z

← Revisión anterior		Revisión del 23:24 17 ago 2022
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	*[[Sympathomimetic overdose]]		*[[Sympathomimetic overdose]]
	*[[Anticholinergic toxicity]]		*[[Anticholinergic toxicity]]

			{{Drugs of abuse types}}

	==Evaluation==		==Evaluation==

Rossdonaldson1 at 23:49, 17 November 2021

2021-11-17T23:49:56Z

← Revisión anterior		Revisión del 23:49 17 nov 2021
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	==Background==		==Background==
	[[File:Kratom leaves.jpg\|thumb\|Kratom flowers and foliage.]]		[[File:Kratom leaves.jpg\|thumb\|Kratom flowers and foliage.]]
			[[File:Powdered kratom.jpg\|thumb\|Typical powdered Kratom for commercial use.]]
	*Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia		*Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia
	*Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors		*Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors

Rossdonaldson1: /* Background */

2021-11-17T23:48:05Z

Background

← Revisión anterior		Revisión del 23:48 17 nov 2021
Línea 1:		Línea 1:
	==Background==		==Background==
			[[File:Kratom leaves.jpg\|thumb\|Kratom flowers and foliage.]]
	*Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia		*Derived from ''Mitragyna speciosa,'' a plant native to Southeast Asia
	*Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors		*Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors

Rossdonaldson1: Rossdonaldson1 moved page Kratom to Kratom toxicity

2021-11-17T23:36:36Z

Rossdonaldson1 moved page Kratom to Kratom toxicity

← Revisión anterior	Revisión del 23:36 17 nov 2021
(Sin diferencias)

ClaireLewis at 17:22, 17 August 2019

2019-08-17T17:22:52Z

← Revisión anterior		Revisión del 17:22 17 ago 2019
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	==Management==		==Management==
	*Management should be tailored to primary symptoms		*Management should be tailored to primary symptoms
	**Naloxone for respiratory depression		**[[Naloxone]] for respiratory depression
	**Benzodiazepines for hyperarousal, tachycardia, hypertension, and seizures		**[[Benzodiazepines]] for hyperarousal, tachycardia, hypertension, and seizures
	**NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms		**[[NSAIDs]], [[antiemetics]], fluids, etc. for [[opioid withdrawal]] symptoms
	***Medication-assisted treatment with buprenorphine or methadone		***Medication-assisted treatment with [[buprenorphine]] or [[methadone]]

	==Disposition==		==Disposition==
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	==See Also==		==See Also==
			*[[Opioids]]

	==External Links==		==External Links==
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	*Killelea E. Kratom: Why Did the FDA Declare the Herbal Supplement an Opiate? Rolling Stone Magazine. March 2018.		*Killelea E. Kratom: Why Did the FDA Declare the Herbal Supplement an Opiate? Rolling Stone Magazine. March 2018.
	*Gottlieb, S. Statement from FDA Commissioner Scott Gottlieb, M.D., on new warning letters FDA is issuing to companies marketing kratom with unproven medical claims; and the agency’s ongoing concerns about kratom [press release]. Sep 11, 2018.		*Gottlieb, S. Statement from FDA Commissioner Scott Gottlieb, M.D., on new warning letters FDA is issuing to companies marketing kratom with unproven medical claims; and the agency’s ongoing concerns about kratom [press release]. Sep 11, 2018.

			[[Category:Toxicology]]

Spenceemmett at 19:32, 27 June 2019

2019-06-27T19:32:05Z

← Revisión anterior		Revisión del 19:32 27 jun 2019
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	*Effects are dose dependent and may mimic those of both opioid and stimulant toxicity		*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		*Stimulant effects typically predominate at low doses (<5 g) with sedating effects more prevalent at higher doses


	==Differential Diagnosis==		==Differential Diagnosis==
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	*Clinical diagnosis		*Clinical diagnosis
	*Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis		*Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis


	==Management==		==Management==
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	**NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms		**NSAIDs, antiemetics, fluids, etc. for opioid withdrawal symptoms
	***Medication-assisted treatment with buprenorphine or methadone		***Medication-assisted treatment with buprenorphine or methadone



	==Disposition==		==Disposition==
	*Discharge unless presenting with severe/intractable symptoms		*Discharge unless presenting with severe/intractable symptoms


	==See Also==		==See Also==


	==External Links==		==External Links==


	==References==		==References==