用苯巴比妥治疗卡瓦戒断--病例报告和文献综述。

IF 4.2 3区 医学 Q1 SUBSTANCE ABUSE Journal of Addiction Medicine Pub Date : 2024-09-01 Epub Date: 2024-05-31 DOI:10.1097/ADM.0000000000001314
Ryan Michael Cassidy, Kalli Burdick, Trevor Anesi, Daniel Daunis
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引用次数: 0

摘要

摘要:食用卡瓦是波利尼西亚和密克罗尼西亚文化中的一种传统习俗。最近,卡瓦在美国越来越流行,用于治疗和娱乐。我们报告了以下病例。一名男子在服用卡瓦酒后摔倒,随后被送往急诊科。他因精神状态改变、面部和锁骨骨折以及低钠血症而入院。精神科对他进行了谵妄治疗。在面谈时,他说尽管曾试图停止服用卡瓦,但连续数周都在不断增加卡瓦的摄入量。他被诊断为急性卡瓦戒断伴多动谵妄,接受了苯巴比妥负荷(860 毫克)和减量(390 毫克)治疗。在住院第 3 天,连续使用右美托咪定滴注治疗交感神经激活和突破性躁动。第 4 天,他的谵妄症状得到缓解,直到出院。我们对有关卡瓦戒断的报告进行了系统回顾,共返回了 9 项研究。其中 8 项研究评估了停用低控制剂量卡瓦提取物后的戒断症状,结果未发现任何症状。一项研究报告了大量卡瓦使用者出现癫痫发作的系列病例。没有任何文献讨论了卡瓦戒断的治疗方法。据我们所知,这是第一份描述卡瓦戒断综合征及其苯巴比妥有效治疗方法的出版物。
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Kava Withdrawal Treated With Phenobarbital-A Case Report and Literature Review.

Abstract: Kava consumption is a traditional practice in Polynesian and Micronesian cultures. It has recently gained popularity in the United States for therapeutic and recreational use. We report the following case. A man presented to the emergency department after a fall while intoxicated on kava. He was medically admitted for altered mental status, facial and clavicle fractures, and hyponatremia. Psychiatry was consulted for management of delirium. On interview, he reported consuming escalating amounts of kava for weeks despite attempts to stop. He was diagnosed with acute kava withdrawal with hyperactive delirium, treated with phenobarbital load (860 mg) and taper (390 mg). Continuous dexmedetomidine drip to hospital day 3 treated sympathetic activation and breakthrough agitation. By day 4, his delirium resolved and remained in remission until discharge. We performed a systematic review for reports of kava withdrawal, returning 9 studies. Eight assessed withdrawal symptoms after cessation of a low controlled dose of kava extract with no symptoms noted. One reported a case series of heavy kava users with seizure-like events. No publications discussed treatment of kava withdrawal. To our knowledge, this is the first publication to describe kava withdrawal syndrome and its effective treatment with phenobarbital.

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来源期刊
Journal of Addiction Medicine
Journal of Addiction Medicine 医学-药物滥用
CiteScore
6.10
自引率
9.10%
发文量
260
审稿时长
>12 weeks
期刊介绍: The mission of Journal of Addiction Medicine, the official peer-reviewed journal of the American Society of Addiction Medicine, is to promote excellence in the practice of addiction medicine and in clinical research as well as to support Addiction Medicine as a mainstream medical sub-specialty. Under the guidance of an esteemed Editorial Board, peer-reviewed articles published in the Journal focus on developments in addiction medicine as well as on treatment innovations and ethical, economic, forensic, and social topics including: •addiction and substance use in pregnancy •adolescent addiction and at-risk use •the drug-exposed neonate •pharmacology •all psychoactive substances relevant to addiction, including alcohol, nicotine, caffeine, marijuana, opioids, stimulants and other prescription and illicit substances •diagnosis •neuroimaging techniques •treatment of special populations •treatment, early intervention and prevention of alcohol and drug use disorders •methodological issues in addiction research •pain and addiction, prescription drug use disorder •co-occurring addiction, medical and psychiatric disorders •pathological gambling disorder, sexual and other behavioral addictions •pathophysiology of addiction •behavioral and pharmacological treatments •issues in graduate medical education •recovery •health services delivery •ethical, legal and liability issues in addiction medicine practice •drug testing •self- and mutual-help.
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