Possible kratom-induced hepatomegaly: A case report

Griffiths, Carrie L.; Gandhi, Nidhi; Olin, Jacqueline L.

doi:10.1016/j.japh.2018.05.006

Cited by 21 publications

(21 citation statements)

References 7 publications

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“…Jaundice was reported in four cases where the total bilirubin was the highest of all KIH cases, ranging from 6.5 mg/dL to 33.7 mg/dL (reference < 1 mg/dL) [58,59,63,64]. After kratom cessation, total bilirubin decreased within 2 days to 7 days [58][59][60][61][62][63][64]. The highest alkaline phosphatase recorded was 790 units/L (reference 35-129 units/L).…”

Section: Interventionmentioning

confidence: 92%

“…Overall, there were 41 cases on kratom-associated adverse events or toxicities (Table 1). Kratom-associated adverse events were as follows: kratom-associated withdrawal symptoms (KAWS) in adults [41][42][43][44][45][46][47][48][49][50][51][52], kratom-associated neonatal abstinence syndrome (KANAS) [48,[52][53][54][55][56], hypothyroidism [43], hypogonadism [57], kratom-induced hepatoxicity (KIH) [58][59][60][61][62][63][64][65], CNS effects causing seizure and coma or posterior reversible encephalopathy syndrome (PRES) [39,66,67], acute respiratory distress syndrome (ARDS) [68,69], overdose toxidrome [70,71], and fatalities [72][73][74][75][76][77][78][79][80]. There were six case series of aggregated patient's data [48,…”

Section: Literature Case Reviewmentioning

confidence: 99%

“…Kratom-Induced Hepatoxicity [58][59][60][61][62][63][64][65] Kratom-induced hepatotoxicity (KIH) has been reported after 2 to 4 weeks of use and rechallenge has led to recurrence [59,65]. The reported dose resulting in KIH was 14 to 21 g per day.…”

Section: Interventionmentioning

confidence: 99%

“…An extensive workup for acute viral hepatitis A, B, and C and assays of hepatotoxic substances such as salicylates, acetaminophen, and CNS medications were used to determine if the exhibited hepatotoxic effects were correlated. Four case reports studied the likelihood of KIH using association scales in which all found a 'probable' association [62][63][64][65]. Scales used included the Roussel Uclaf Causality Assessment Method, World Health Organization Uppsala Monitoring Centre and the International Organizations of Medical Sciences Scale.…”

Section: Interventionmentioning

confidence: 99%

“…Early reports of KIH confirmed intrahepatic cholestasis based on hepatic function tests, abdominal and hepatic imaging, and histological findings. More recently, two case reports highlighted the possibility of a hepatocellular injury [62,65]. Both of these two cases had confounding causes for hepatocellular injury, including positive IgM for cytomegalovirus [65] and positive urine cannabinoid [62].…”

Section: Interventionmentioning

confidence: 99%

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Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

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Purpose of Review This review describes case reports for patients with kratom-associated adverse events in order to assist clinicians with patient management. A stepwise approach is proposed for assessing active kratom users as well as considerations for the management of toxicities or withdrawal. Recent Findings Multiple in vitro and in vivo studies illustrate the pharmacologic and toxicologic effects of kratom extract. No randomized controlled trials in humans exist that assess the safety and efficacy of the substance. Cross-sectional surveys from active users and reports from poison control centers have shown acute and chronic physiological and psychological adverse events. Summary Reports of adverse effects associated with kratom use have demonstrated hypothyroidism, hypogonadism, hepatitis, acute respiratory distress syndrome, posterior reversible encephalopathy syndrome, seizure, and coma. Overdose toxidrome leads to respiratory failure, cardiac arrest, and fatalities. Adult and neonatal withdrawal symptoms have also occurred. Clinicians should be aware of the risks and benefits of kratom use.

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Section: Interventionmentioning

confidence: 92%

Section: Literature Case Reviewmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

See 3 more Smart Citations

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

View full text Add to dashboard Cite

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Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Hartley

Bulloch

Penzak

2022

The Journal of Clinical Pharma

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Kratom (Mitragyna speciosa) consists of over 40 alkaloids, with 2 of them, mitragynine and 7-OH-mitragynine (7-OH-MG) being the main psychoactive compounds. Mitragynine and 7-OH-mitragynine each target opioid receptors and have been referred to as atypical opioids. They exert their pharmacologic effects on the mu, delta, and kappa opioid receptors. In addition, they affect adrenergic, serotonergic, and dopaminergic pathways. Kratom has been touted as an inexpensive, legal alternative to standard opioid replacement therapy such as methadone and buprenorphine. Other uses for kratom include chronic pain, attaining a "legal high," and numerous central nervous system disorders, including anxiety, depression, and posttraumatic stress disorder. Kratom induces analgesia and mild euphoria, with a lower risk of respiratory depression or adverse central nervous system effects compared to traditional opioid medications. Nonetheless, kratom has been associated with both physical and psychological dependence, with some individuals experiencing classic opioid withdrawal symptoms upon abrupt cessation. Kratom use has been linked to serious adverse effects, including liver toxicity, seizures, and death. These risks are often compounded by polysubstance abuse. Further, kratom may potentiate the toxicity of coadministered medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes. In 2016, the US Drug Enforcement Administration took steps to classify kratom as a federal schedule 1 medication; however, due to public resistance, this plan was set aside. Until studies are conducted that define kratom's role in treating opioid withdrawal and/or other central nervous system conditions, kratom will likely remain available as a dietary supplement for the foreseeable future.

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Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

2020

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Kratom, or Mitragyna, is a tropical plant indigenous to Southeast Asia, with unique pharmacological properties. It is commonly consumed by preparing the leaves into decoction or tea, or by grinding them into a powder. Recent evidence has revealed that kratom has physiological effects similar to opioids, including pain relief and euphoria, as well as stimulant properties, which together raise potential concern for dependence and addiction. Moreover, growing evidence suggests that the prevalence of kratom use is increasing in many parts of the world, raising important considerations for healthcare providers. This manuscript will discuss the most current epidemiology, pharmacology, toxicity, and management related to kratom, while seeking to provide a contemporary perspective on the issue and its role in the greater context of the opioid epidemic.

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Possible kratom-induced hepatomegaly: A case report

Cited by 21 publications

References 7 publications

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Clinical Pharmacology of the Dietary Supplement Kratom (Mitragyna speciosa)

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

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