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Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure.

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.
AuthorsJamie L Nelsen, Jeff Lapoint, Michael J Hodgman, Kenneth M Aldous
JournalJournal of medical toxicology : official journal of the American College of Medical Toxicology (J Med Toxicol) Vol. 6 Issue 4 Pg. 424-6 (Dec 2010) ISSN: 1937-6995 [Electronic] United States
PMID20411370 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Anticonvulsants
  • Plant Extracts
  • Secologanin Tryptamine Alkaloids
  • Phenytoin
  • mitragynine
Topics
  • Anticonvulsants (therapeutic use)
  • Chromatography, High Pressure Liquid
  • Coma (chemically induced, urine)
  • Glasgow Coma Scale
  • Humans
  • Intubation, Intratracheal
  • Male
  • Middle Aged
  • Mitragyna (chemistry)
  • Phenytoin (therapeutic use)
  • Plant Extracts (poisoning)
  • Poisoning (etiology, therapy, urine)
  • Secologanin Tryptamine Alkaloids (poisoning, urine)
  • Seizures (chemically induced, urine)
  • Spectrometry, Mass, Electrospray Ionization
  • Treatment Outcome

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