Abstract
Reports of toxicity secondary to Kratom are rare and lack of diagnostic testing in human specimens has prevented confirmatory explanation of observed clinical effects. We present a novel case of serious human toxicity following Kratom use confirmed via quantitative analysis of urine by high performance liquid chromatography coupled to electrospray tandem mass spectrometry. A 64 year-old male was witnessed to have a seizure at home following kratom consumption. Upon arrival to the emergency department (ED), the patient was unresponsive. While in the ED, the patient sustained a second seizure. He was intubated to protect his airway. The remainder of his hospital course was uneventful. A urine specimen was collected shortly after admission and sent for analysis. The mitragynine concentration in the urine was 167 ± 15 ng/ml. We report a rare case of Kratom toxicity characterized by a seizure and coma confirmed by urinary analysis of mitragynine by high performance liquid chromatography coupled to electrospray tandem mass spectrometry. The proposed mechanism for this reaction is unclear but suggested mechanisms include adenosine binding or stimulation of adrenergic and/or serotonergic receptors similar to tramadol.
Keywords: Kratom, Mitragynina speciosa Korth, Seizure, Coma
Full Text
The Full Text of this article is available as a PDF (82.2 KB).
Footnotes
This report was presented as a Platform Presentation: NACCT 2009, San Antonio, TX. AACT’s SIG on Herbs and Dietary Supplements.
References
- 1.Lu S, Tran BN, Nelsen JL, Aldous KM. Quantitative analysis of mitragynine in human urine by high performance liquid chromatography-tandem mass spectrometry. J Chromatogr B Analyt Technol Biomed Life Sci [Internet] 2009;24:2499–2505. doi: 10.1016/j.jchromb.2009.06.024. [DOI] [PubMed] [Google Scholar]
- 2.Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa Korth) Addiction. 2008;103(6):1048–1050. doi: 10.1111/j.1360-0443.2008.02209.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Roche KM, Hart K, Sangalli B, Lefberg J, Bayer M (2008) Kratom: a case of a legal high. Clin Tox 46(7):598
- 4.Takayama H. Chemistry and pharmacology of analgesic indole alkaloids from the rubiaceous plant, mitragyna speciosa. Chem Pharm Bull (Tokyo) 2004;52(8):916–928. doi: 10.1248/cpb.52.916. [DOI] [PubMed] [Google Scholar]
- 5.Matsumoto K, Mizowaki M, Suchitra T, Murakami Y, Takayama H, Sakai S, Aimi N, Watanabe H. Central antinociceptive effects of mitragynine in mice: contribution of descending noradrenergic and serotonergic systems. Eur J Pharmacol. 1996;317(1):75–81. doi: 10.1016/s0014-2999(96)00714-5. [DOI] [PubMed] [Google Scholar]
- 6.Matsumoto K, Horie S, Ishikawa H, Takayama H, Aimi N, Ponglux D, Watanabe K. Antinociceptive effect of 7-hydroxymitragynine in mice: discovery of an orally active opioid analgesic from the thai medicinal herb mitragyna speciosa. Life Sci. 2004;74(17):2143–2155. doi: 10.1016/j.lfs.2003.09.054. [DOI] [PubMed] [Google Scholar]
- 7.Janchawee B, Keawpradub N, Chittrakarn S, Prasettho S, Wararatananurak P, Sawangjareon K. A high-performance liquid chromatographic method for determination of mitragynine in serum and its application to a pharmacokinetic study in rats. Biomed Chromatogr. 2007;21(2):176–183. doi: 10.1002/bmc.731. [DOI] [PubMed] [Google Scholar]
- 8.de Moraes NV, Moretti RAC, Furr III EB, McCurdy CR, Lanchote VL (2009) Determination of mitragynine in rat plasma by LC-MS/MS: application to pharmacokinetics. J Chromatogr B 877(24):2593-2597 [DOI] [PMC free article] [PubMed]
- 9.Mikolich JR, Paulson GW, Cross CJ. Acute anticholinergic syndrome due to jimson seed ingestion. Ann Intern Med. 1975;83(3):321–325. doi: 10.7326/0003-4819-83-3-321. [DOI] [PubMed] [Google Scholar]