SHM Converge Scientific Abstract ePoster Gallery-Piecing the Puzzle: The Vital Role of History Taking in Detecting Kratom-Linked Liver Injury

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This case highlights the importance of detailed history-taking in patients with acute liver injury, especially regarding herbal products and supplements. A 41-year-old woman with ADHD and chronic back pain presented with two weeks of progressive jaundice, dark urine, and clay-colored stools after a recent trip that included heavy alcohol use. Initial evaluation showed a mixed/cholestatic liver injury pattern with elevated AST, ALT, bilirubin, and mildly elevated INR. Standard workup for infectious, autoimmune, metabolic, and drug-related causes was largely negative.<br /><br />Because the cause remained unclear, the team performed a “diagnostic time-out” and revisited her history at the bedside. She then disclosed long-term use of an herbal supplement for back pain containing kratom, taken several times weekly for years. Kratom is an opioid-like herbal product increasingly recognized as a rare cause of herb-induced liver injury (HILI). It is often used for self-treatment of pain, and patients typically present with jaundice and a mixed or cholestatic liver test pattern.<br /><br />Her liver injury was attributed to kratom, and she was advised to stop it permanently. Her liver tests improved spontaneously during hospitalization and continued to recover after discharge. The case also raised concern that heavy alcohol use may have contributed, although the extent of alcohol-related injury was uncertain.<br /><br />Key takeaways: clinicians should routinely ask about unregulated herbal and dietary supplements in patients with liver injury, and kratom should be considered as a potential cause of unexplained jaundice and ALI.

Asset Subtitle

Sanjna Surya

Meta Tag

Author List Luke Vest, Sanjna Surya, Vatsal Y. Bhatt

Category Clinical Vignettes

Concept Acute Liver Injury

Concept Kratom

Concept History Taking

Concept Herb-Induced Liver Injury

Concept Herbal Products

Distinguished Non-Finalist

Presenter Organization Brigham and Women's Hospital

Presenting Author Sanjna Surya

Track Adult

Keywords

acute liver injury

herbal supplements

kratom

jaundice

cholestatic liver injury

mixed liver injury

history-taking

herb-induced liver injury

alcohol use

liver tests

Acute Liver Injury

Kratom

History Taking

Herb-Induced Liver Injury

Herbal Products