Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure.
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.
Nelsen
Jamie L
JL
Department of Emergency Medicine, SUNY Upstate Medical University, Upstate New York Poison Center, 250 Harrison Street, Syracuse, NY 13210, USA. nelsenj@upstate.edu
Lapoint
Jeff
J
Hodgman
Michael J
MJ
Aldous
Kenneth M
KM
D000927:Anticonvulsants / Q000627:therapeutic use; D002851:Chromatography, High Pressure Liquid; D003128:Coma / Q000139:chemically induced* / Q000652:urine; D015600:Glasgow Coma Scale; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D032065:Mitragyna / Q000737:chemistry*; D010672:Phenytoin / Q000627:therapeutic use; D010936:Plant Extracts / Q000506:poisoning; D011041:Poisoning / Q000209:etiology* / Q000628:therapy / Q000652:urine; D046948:Secologanin Tryptamine Alkaloids / Q000506:poisoning* / Q000652:urine; D012640:Seizures / Q000139:chemically induced* / Q000652:urine; D021241:Spectrometry, Mass, Electrospray Ionization; D016896:Treatment Outcome
D000927:Anticonvulsants; D010936:Plant Extracts; D046948:Secologanin Tryptamine Alkaloids; D010672:Phenytoin; C001801:mitragynine
Ann Intern Med. 1975 Sep;83(3):321-5
1180428
J Chromatogr B Analyt Technol Biomed Life Sci. 2009 Aug 15;877(24):2593-7
19589735
Biomed Chromatogr. 2007 Feb;21(2):176-83
17221920
Addiction. 2008 Jun;103(6):1048-50
18482427
Life Sci. 2004 Mar 12;74(17):2143-55
14969718
J Chromatogr B Analyt Technol Biomed Life Sci. 2009 Aug 15;877(24):2499-505
19577523
Chem Pharm Bull (Tokyo). 2004 Aug;52(8):916-28
15304982
Eur J Pharmacol. 1996 Dec 12;317(1):75-81
8982722