title: Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa).
abstract: BACKGROUND
  Kratom (Mitragyna speciosa) is a common medical plant in Thailand and is known to contain mitragynine as the main alkaloid. According to an increase in published reports and calls at German poison control centers, it has been used more frequently as a drug of abuse in the western hemisphere during the last couple of years. Despite this increase, reports of severe toxicity are rare within the literature.
  
  
  METHODS
  We describe a case of a young man who presented with jaundice and pruritus after intake of kratom for 2 weeks in the absence of any other causative agent. Alkaloids of M. speciosa were detected in the urine.
  
  
  CONCLUSIONS
  While M. speciosa is gaining in popularity among illicit drug users, its adverse effects remain poorly understood. This is the first published case of intrahepatic cholestasis after kratom abuse.
authors.affiliation: Poisons Information Center VIZ-Freiburg, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany. friedrich.kapp@uniklinik-freiburg.de
authors.forename: Friedrich G
authors.initials: FG
authors.lastname: Kapp
authors.forename: Hans H
authors.initials: HH
authors.lastname: Maurer
authors.forename: Volker
authors.initials: V
authors.lastname: Auwärter
authors.forename: Martin
authors.initials: M
authors.lastname: Winkelmann
authors.forename: Maren
authors.initials: M
authors.lastname: Hermanns-Clausen
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000470:Alkaloids / Q000652:urine; D001663:Bilirubin / Q000097:blood; D002780:Cholestasis, Intrahepatic / Q000209:etiology*; D002851:Chromatography, High Pressure Liquid; D062787:Drug Overdose; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D032065:Mitragyna / Q000737:chemistry; D011208:Powders; D046948:Secologanin Tryptamine Alkaloids / Q000097:blood / Q000652:urine; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D000470:Alkaloids; D011208:Powders; D046948:Secologanin Tryptamine Alkaloids; C001801:mitragynine; D001663:Bilirubin