title: Mitragynine concentrations in two fatalities.
abstract: Two cases of fatalities are reported of which the recreational use of Mitragyna speciosa ("kratom") could be confirmed. One of these cases presents with one of the highest postmortem mitragynine concentrations published to date. Our results show that even extremely high mitragynine blood concentrations following the consumption of kratom do not necessarily have to be the direct cause of death in such fatalities as a result of an acute overdose. The two cases are compared with regard to the differences in mitragynine concentrations detected and the role of mitragynine in the death of the subjects. Irrespective of the big differences in mitragynine concentrations in the postmortem blood samples, mitragynine was not the primary cause of death in either of the two cases reported here. Additionally, by rough estimation, a significant difference in ratio of mitragynine to its diastereomers in the blood and urine samples between the two cases could be seen.
authors.affiliation: Institute of Forensic Medicine, Department of Toxicology, University of Munich, 80336 Munich, Germany. Electronic address: Olwen.Groth@med.uni-muenchen.de.
authors.forename: Olwen
authors.initials: O
authors.lastname: Domingo
authors.affiliation: Institute of Forensic Medicine, Department of Toxicology, University of Munich, 80336 Munich, Germany.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Roider
authors.affiliation: Institute of Forensic Medicine, Department of Toxicology, University of Munich, 80336 Munich, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Stöver
authors.affiliation: Institute of Forensic Medicine, Department of Toxicology, University of Munich, 80336 Munich, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Graw
authors.affiliation: Forensic Toxicological Center (FTC), 80335 Munich, Germany.
authors.forename: Frank
authors.initials: F
authors.lastname: Musshoff
authors.affiliation: Forensic Toxicological Center (FTC), 80335 Munich, Germany.
authors.forename: Hans
authors.initials: H
authors.lastname: Sachs
authors.affiliation: FTC-Forensic-Toxicological Laboratory, 1120 Vienna, Austria.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Bicker
mesh_terms: D006801:Humans; D008297:Male; D032065:Mitragyna; D009294:Narcotics / Q000032:analysis; D010936:Plant Extracts; D018515:Plant Leaves; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000032:analysis*; D053120:Respiratory Aspiration / Q000473:pathology; D046948:Secologanin Tryptamine Alkaloids / Q000009:adverse effects* / Q000032:analysis*; D019966:Substance-Related Disorders / Q000150:complications*; D014474:Unconsciousness / Q000139:chemically induced; D055815:Young Adult
chemical_list: D009294:Narcotics; D010936:Plant Extracts; D011619:Psychotropic Drugs; D046948:Secologanin Tryptamine Alkaloids; C001801:mitragynine
keywords: Concentration dependent effects; Diastereomers; Kratom; Mitragynine; “Legal high”