Mitragynine concentrations in two fatalities

Domingo, Olwen; Roider, Gabriele; Stöver, Andreas; Graw, Matthias; Mußhoff, Frank; Sachs, Hans; Bicker, Wolfgang

doi:10.1016/j.forsciint.2016.12.020

Cited by 53 publications

(40 citation statements)

References 36 publications

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“…In one case, the urine concentration of MG was measured at 0.167 mg/L. Interestingly, this level is half the MG urine concentration in reported fatalities (range from 0.37 to 3.47 mg/L) [72,74,76,77].…”

Section: Interventionmentioning

confidence: 81%

“…Kratom-associated adverse events were as follows: kratom-associated withdrawal symptoms (KAWS) in adults [41][42][43][44][45][46][47][48][49][50][51][52], kratom-associated neonatal abstinence syndrome (KANAS) [48,[52][53][54][55][56], hypothyroidism [43], hypogonadism [57], kratom-induced hepatoxicity (KIH) [58][59][60][61][62][63][64][65], CNS effects causing seizure and coma or posterior reversible encephalopathy syndrome (PRES) [39,66,67], acute respiratory distress syndrome (ARDS) [68,69], overdose toxidrome [70,71], and fatalities [72][73][74][75][76][77][78][79][80]. There were six case series of aggregated patient's data [48,49,51,…”

Section: Literature Case Reviewmentioning

confidence: 99%

“…Toxidromes and Fatalities [70][71][72][73][74][75][76][77][78][79][80] Kratom toxicity is presumed to resemble an opioid toxidrome: manifested by mydriasis, depressed respiratory function, altered mental status, hypotension, and hypothermia. Two recent case reports showed the role of naloxone reversal on the kratom toxidrome, although it was administered due to suspected co-intoxication with an opioid [70,71].…”

Section: Interventionmentioning

confidence: 99%

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Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

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Purpose of Review This review describes case reports for patients with kratom-associated adverse events in order to assist clinicians with patient management. A stepwise approach is proposed for assessing active kratom users as well as considerations for the management of toxicities or withdrawal. Recent Findings Multiple in vitro and in vivo studies illustrate the pharmacologic and toxicologic effects of kratom extract. No randomized controlled trials in humans exist that assess the safety and efficacy of the substance. Cross-sectional surveys from active users and reports from poison control centers have shown acute and chronic physiological and psychological adverse events. Summary Reports of adverse effects associated with kratom use have demonstrated hypothyroidism, hypogonadism, hepatitis, acute respiratory distress syndrome, posterior reversible encephalopathy syndrome, seizure, and coma. Overdose toxidrome leads to respiratory failure, cardiac arrest, and fatalities. Adult and neonatal withdrawal symptoms have also occurred. Clinicians should be aware of the risks and benefits of kratom use.

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Section: Interventionmentioning

confidence: 81%

Section: Literature Case Reviewmentioning

confidence: 99%

Section: Interventionmentioning

confidence: 99%

See 1 more Smart Citation

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Alsarraf

Myers

Culbreth

et al. 2019

Curr Emerg Hosp Med Rep

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“…It is an opioid‐receptor agonist and is classified as an opioid. Mitragynine is believed to show concentration‐dependent effects with stimulant activity at lower concentration and depressant activity at higher concentrations . Mitragynine is not the only active component of Kratom; at least 20‐25 other pharmacoactive alkaloids have been isolated.…”

Section: Resultsmentioning

confidence: 99%

To Test or Not To Test?: The Value of Toxicology in a Delayed Overdose Death

Walsh

Shoff

Zaney

et al. 2018

Journal of Forensic Sciences

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A case demonstrating the necessity of thorough death investigation processes where toxicology plays an active role is presented. A 33-year-old white man presented to the emergency room in respiratory distress after an overdose episode where he was revived on the scene by fire rescue. His condition continued to deteriorate and he expired 6 days after the initial incident. No admission specimens were available for testing; however, there were specimens drawn 4 and 5 days after the incident. Drug paraphernalia from the scene was obtained by the laboratory through collaboration with local law enforcement. Drug paraphernalia was initially tested in the laboratory and after obtaining the results, the antemortem and postmortem specimens were tested identifying mitragynine and U-47700, among other drugs. These results indicate the value in obtaining and testing drug paraphernalia, and the value of testing antemortem specimens even in the event of a delay.

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“…Though kratom has been used in the USA for a while, it came into spotlight in 2016 when the Drug Enforcement Agency banned it, but then had to backtrack due to public backlash. In 2018, the Food and Drug Administration reported the number of kratom associated deaths between 2011 and 2017 at 44 7 10 28 29. There is an ongoing discussion about the need for regulating the use of kratom in the USA and other western countries.…”

Section: Discussionmentioning

confidence: 99%

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

Abdullah¹,

Haq

Lamfers

2019

BMJ Case Rep

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Kratom is a psychoactive herb that has stimulant properties at low doses and has opioid-like properties at higher doses. It has been used for centuries in southeast Asia as a stimulant but has gained increasing popularity as a substitute for opioids in western countries as it is easily available. As most cases of kratom use involve other drugs too, the Food and Drug Administration (FDA) has stopped short of restricting kratom due to difficulty in assessing the adverse effects of kratom alone. We present the case of a young healthy 35-year-old man who suffered a cardiac arrest due to kratom use with no other coingestants. He was subsequently intubated and found to have systolic dysfunction and small brain infarcts. Fortunately, he made a successful recovery and was discharged after a stay at thebehavioural health centre. Our case highlights the potential adverse effects of kratom and the need to regulate its use.

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Mitragynine concentrations in two fatalities

Cited by 53 publications

References 36 publications

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

Kratom from Head to Toe—Case Reviews of Adverse Events and Toxicities

To Test or Not To Test?: The Value of Toxicology in a Delayed Overdose Death

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

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