eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2022-09-05 10 9 214 217 10.12691/ajmcr-10-9-1 AJMCR20221091 article Reece Vesperman peacevesman@gmail.com 1 Shalinee Wayland 1 Shemar Crawford 1 Corinne Jackson 2 Pensacola Regional Campus, Florida State University College of Medicine, Pensacola, United States of America Department of Emergency Medicine, Baptist Hospital, Pensacola, United States of America Kratom (Mitragyna speciosa Korth), an indigenous herb of Southeast Asia, is popularly used to treat withdrawal symptoms associated with opiate addiction and a myriad of ailments including chronic pain, anxiety and hypertension. Its use has significantly increased in western countries because of its widespread advertisement on the internet as a safe, nonaddictive alternative treatment of pain and opioid dependent disorders. This report describes the first emergency case of toxic encephalopathy, rhabdomyolysis, and liver injury in relation to kratom withdrawal syndrome induced by naltrexone in a 49-year old male. The symptoms were resolved with a regimen of dexmedetomidine, lorazepam, oral lactulose, and a bicarbonate drip. Outpatient treatment with lorazepam and tramadol was recommended for further withdrawal symptoms. http://pubs.sciepub.com/ajmcr/10/9/1/ajmcr-10-9-1.pdf kratom withdrawal opioid toxicity naltrexone