Kratom can be classified as both an opioid and a stimulant. There have been many deaths attributed to kratom, though most of the victims had also taken other substances that may have caused death. It is sometimes sold as a green powder in packets labeled “not for human consumption.” It has many street names, such as biak, ketum, kakuam, ithang, and thom. Kratom can be ingested in many ways, including being taken as a pill, an extract, being smoked, put in food, or even sold as a gum. Kratom is a tree native to Southeast Asia known for its psychotropic properties and is easily obtained over the Internet. Further documentation of case reports and research is required to learn the associated risks of the use of this substance. This opioid family alternative substance is gaining popularity across the USA in the era of the opioid crisis. A unique aspect of this case is the circumstance by which this toxicity took place: a family member who chronically takes this substance (that requires increasing dosages to remain effective) recommended a dosage to this kratom-naïve patient, leading to overdose. We present a classic case of a novel acute toxicity: kratom. She came to the ED, where she required multiple rounds of anti-emetic medication for resolution of her symptoms. She took two “scoops.” She proceeded to have multiple episodes of vomiting at home. She was recommended kratom from a family member, who stated he was using kratom to transition away from opioid dependence. After a day of yard work, she was in pain, secondary to her osteoporotic joints. We present the case of a 62-year-old woman arriving to the emergency department (ED) with a chief complaint of intractable vomiting after ingestion of kratom. Here, we present a novel case of acute toxicity from overdose in a kratom-naïve patient, taking place through recommendation by a family member who chronically takes this substance. Although kratom use dates back to the 1800s in Asia, kratom intoxication is still a novel (but increasing) toxidrome in the Western world. Chronic users require increasing dosages for the analgesic effects. Kratom is a habit-forming opioid-like substance with an acute toxidrome of various symptoms such as diaphoresis, dizziness, nausea, and vomiting.
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