Cardiac arrest in a young healthy male patient secondary to kratom ingestion: is this ’legal high' substance more dangerous than initially thought ?

Abdullah, Hafez Mohammad Ammar; Haq, Iqra; Lamfers, Randall

doi:10.1136/bcr-2019-229778

Cited by 18 publications

(14 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In this case as well, however, the authors did not assess the patient’s serum mitragynine or 7-HMG levels. Moreover, the amount of kratom that the patient had ingested daily was not well quantified ( Abdullah et al, 2019 ).…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the findings of in vitro studies on cardiotoxicity should not be exclusively extrapolated to represent cardiotoxicity risk in humans. Second, despite a few case reports suggesting cardiotoxicity related to kratom use, the patients described in these case reports had either co-administered kratom with other substances ( Aggarwal et al, 2018 ; Sheikh et al, 2021 ) or had a long, established history of polysubstance use that may have led them to co-administer kratom with other illicit substances ( Abdullah et al, 2019 ; Eljack et al, 2020 ). Unfortunately, these case reports did not assess patients’ serum mitragynine levels.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Adverse Cardiovascular Effects and Cardiotoxicity of Kratom (Mitragyna speciosa Korth.): A Comprehensive Review

Abdullah

Singh

2021

Front. Pharmacol.

View full text Add to dashboard Cite

Background: Kratom or Mitragyna speciosa (Korth.) has received overwhelming attention recently due to its alleged pain-relieving effects. Despite its potential therapeutic value, kratom use has been linked to many occurrences of multiorgan toxicity and cardiotoxicity. Accordingly, the current narrative review aimed to provide a detailed account of kratom’s adverse cardiovascular effects and cardiotoxicity risk, based on in vitro studies, poison center reports, coroner and autopsy reports, clinical case reports, and clinical studies.Methods: An electronic search was conducted to identify all research articles published in English from 1950 to 2021 using the major research databases, such as Google Scholar, Web of Science, PubMed, Scopus, Mendeley, EMBASE, Cochrane Library, and Medline. We then analyzed the literature’s discussion of adverse cardiovascular effects, toxicity, and mortality related to kratom use.Results: Our findings revealed that, although in vitro studies have found kratom preparations’ most abundant alkaloid—mitragynine—to cause a prolonged QTc interval and an increased risk of torsades de pointes, a clinical study examining humans’ regular consumption of kratom did not report such a risk. However, this latter study did show that regular kratom use could induce an increased QTc interval in a dose-dependent manner. A few case reports also highlighted that kratom consumption is associated with ventricular arrhythmia and cardiopulmonary arrest, but this association could have ensued when kratom was co-administered with another substance. Similarly, analyses of national poison data showed that kratom’s most common adverse acute cardiovascular effects include tachycardia and hypertension. Meanwhile, coroner and autopsy reports indicated that kratom’s cardiovascular sequelae encompass coronary atherosclerosis, myocardial infarction, hypertensive cardiovascular disease, left ventricular hypertrophy, cardiac arrhythmia, cardiomegaly, cardiomyopathy, focal band necrosis in the myocardium, and myocarditis. Given the available data, we deduced that all cardiac eventualities reported in the literature could have been compounded by polysubstance use and unresolved underlying medical illnesses.Conclusion: Although kratom use has been associated with death and cardiotoxicity, especially at higher doses and when associated with other psychoactive drugs, the dearth of data and methodological limitations reported in existing studies do not allow a definitive conclusion, and further studies are still necessary to address this issue.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Adverse Cardiovascular Effects and Cardiotoxicity of Kratom (Mitragyna speciosa Korth.): A Comprehensive Review

Abdullah

Singh

2021

Front. Pharmacol.

View full text Add to dashboard Cite

show abstract

“…Case studies reveal that a wide range of organ systems are susceptible to kratom-mediated injury (Table 1). For example, instances of kidney injury [67], cardiotoxicity and arrhythmia [98,99], thyroid injury and hypothyroidism [100] lung injury/acute respiratory distress syndrome (ARDS) [101,102], neonatal abstinence syndrome, [103][104][105][106][107] and hepatic injury [23,[108][109][110][111][112][113][114][115][116] have all been linked to kratom.…”

Section: Clinical Presentations Of Kratom Abusementioning

confidence: 99%

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

2020

View full text Add to dashboard Cite

Kratom, or Mitragyna, is a tropical plant indigenous to Southeast Asia, with unique pharmacological properties. It is commonly consumed by preparing the leaves into decoction or tea, or by grinding them into a powder. Recent evidence has revealed that kratom has physiological effects similar to opioids, including pain relief and euphoria, as well as stimulant properties, which together raise potential concern for dependence and addiction. Moreover, growing evidence suggests that the prevalence of kratom use is increasing in many parts of the world, raising important considerations for healthcare providers. This manuscript will discuss the most current epidemiology, pharmacology, toxicity, and management related to kratom, while seeking to provide a contemporary perspective on the issue and its role in the greater context of the opioid epidemic.

show abstract

“…A 33-year-old male polysubstance user exhibited cardiovascular shock features and high procalcitonin levels promptly treated with vasopressors ( 81 ). An otherwise healthy 35-year-old man suffered a cardiac arrest after using kratom alone and was found with small brain infarcts, but recovered spontaneously ( 82 ). Finally, a 62-year-old woman who used kratom for the first time to soothe traumatic pain presented at the emergency room with intractable vomiting and nausea that responded to ondansetron, promethazine, and famotidine ( 83 ).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

Vento

Persis²,

Filippis³

et al. 2021

Front. Psychiatry

View full text Add to dashboard Cite

Kratom or Mitragyna speciosa (Korth.) is an evergreen tree of the coffee family native to South-East Asia and Australasia. It is used by locals recreationally to induce stimulant and sedative effects and medically to soothe pain and opiate withdrawal. Its leaves are smoked, chewed, or infused, or ground to yield powders or extracts for use as liquids. It contains more than 40 alkaloids; among these, mitragynine and 7-hydroxymitragynine are endowed with variable mu, delta, and kappa opioid stimulating properties (with 7-hydroxymitragynine having a more balanced affinity), rhynchophylline, which is a non-competitive NMDA glutamate receptor antagonist, but is present in negligible quantities, and raubasine, which inhibits α1-adrenceptors preferentially over α2-adrenceptors, while the latter are bound by 7-hydroxymitragynine, while mitragynine counters 5-HT2A receptors. This complexity of neurochemical mechanisms may account for kratom's sedative-analgesic and stimulant effects. It is commonly held that kratom at low doses is stimulant and at higher doses sedative, but no cut-off has been possible to define. Long-term use of kratom may produce physical and psychological effects that are very similar to its withdrawal syndrome, that is, anxiety, irritability, mood, eating, and sleep disorders, other than physical symptoms resembling opiate withdrawal. Kratom's regulatory status varies across countries; in Italy, both mitragynine and the entire tree and its parts are included among regulated substances. We describe the case of a patient who developed anxiety and dysphoric mood and insomnia while using kratom, with these symptoms persisting after withdrawal. He did not respond to a variety of antidepressant combinations and tramadol for various months, and responded after 1 month of clomipramine. Well-being persisted after discontinuing tramadol.

show abstract

Cardiac arrest in a young healthy male patient secondary to kratom ingestion: is this ’legal high' substance more dangerous than initially thought ?

Cited by 18 publications

References 34 publications

The Adverse Cardiovascular Effects and Cardiotoxicity of Kratom (Mitragyna speciosa Korth.): A Comprehensive Review

The Adverse Cardiovascular Effects and Cardiotoxicity of Kratom (Mitragyna speciosa Korth.): A Comprehensive Review

Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

Contact Info

Product

Resources

About