Kratom-induced Liver Failure and Death: A Case Report
Journal of the Academy of Consultation-Liaison Psychiatry
; 63:S52, 2022.
Article
in English
| EMBASE | ID: covidwho-1966667
ABSTRACT
Introduction:
Kratom (mitragynine speciosa) is a tree native to Southeast Asia that has both opioid, stimulant, and other unknown properties. It is currently legal in the United States and used for therapeutic and recreational purposes. There is a dearth of literature on kratom’s effects on the body. At least half of reported kratom exposures resulted in a serious medical outcome, including death (1). In contrast, there are no controlled clinical trials on safety and efficacy of kratom as a treatment (2). Case A 32-year-old Caucasian, currently unemployed, unmarried, mother of two children presented intubated to the MICU from an outside hospital with acute fulminant hepatic failure in the setting of significant kratom use. The patient also presented febrile with intracranial hemorrhage, cerebral edema, GI bleeding, acute renal failure, and diffuse intravascular coagulation. Psychiatry was consulted for potential liver transplant candidacy. Her previous history included six years of opioid use and transition to kratom 1-2 years prior to admission, with recent ingestion up to twenty-five times the patient’s usual amount (up to 125mg). Pertinent positive labs included elevated troponin (0.4), transaminitis ( >11,000), elevated PT/PTT (99/52), D-dimer ( >20), hematuria, pyuria, serum ferritin, prolonged QTc (514), and hypoglycemia. Pertinent negatives included unrevealing serum ethanol, phosphatidylethanol, viral hepatitis, HIV, COVID-19, EBV, CMV, other viral panels, acetaminophen level, toxicology screen, and EEG. Imaging revealed interstitial pulmonary edema and diffuse cerebral edema. Given lack of published information on kratom, the team emergently listed the patient for liver transplant despite significant concern for kratom use disorder. Over the course of three days, the patient’s mental status and labs continued to worsen, ultimately resulting in death. Interventions pursued included dialysis, mechanical ventilation, intracranial pressure monitoring with pressure optimization, anticonvulsant therapy, antibiotic therapy, N-acetylcysteine, and other routine MICU care. Due to relatively unremarkable health before ingestion, lack of other significant events, and severe rapid decline, multidisciplinary team consensus cause of death was due to kratom ingestion causing “acute liver failure with hepatic coma”.Discussion:
This case report will go into further detail on kratom by analyzing kratom’s mechanism of action, therapeutic use, known side effects including addictive potential, effects on the liver including acute fulminant injury, and current laws and regulations surrounding kratom in the United States with relevance to public health. This is relevant to psychiatrists in the general consult, transplant, and addictions services. References 1. Post S, Spiller HA, Chounthirath T, Smith GA. Kratom exposures reported to United States poison control centers 2011–2017. Clinical Toxicology. 2019 5710,847-854. DOI10.1080/15563650.2019.1569236 2. Prozialeck W. Update on the Pharmacology and Legal Status of Kratom. J of the AOA. 2016, 116, 802-809. DOI https//doi.org/10.7556/jaoa.2016.156
acetylcysteine; D dimer; endogenous compound; opiate; paracetamol; troponin; acute kidney failure; acute liver failure; addiction; adult; alcohol blood level; antibiotic therapy; anticonvulsant therapy; artificial ventilation; brain edema; brain hemorrhage; case report; Caucasian; cause of death; child; clinical article; conference abstract; consensus; controlled clinical trial (topic); coronavirus disease 2019; dialysis; disseminated intravascular clotting; drug safety; electroencephalogram; female; ferritin blood level; fulminant hepatic failure; gastrointestinal hemorrhage; hematuria; hepatic coma; human; Human immunodeficiency virus; human tissue; hypertransaminasemia; hypoglycemia; ingestion; intracranial pressure monitoring; liver failure; liver graft; lung edema; mental health; Mitragyna speciosa; multidisciplinary team; nonhuman; poison center; psychiatrist; psychiatry; public health; pyuria; QT prolongation; side effect; single parent; surgery; toxicology; unemployment; United States; virus hepatitis
Full text:
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Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Case report
Language:
English
Journal:
Journal of the Academy of Consultation-Liaison Psychiatry
Year:
2022
Document Type:
Article
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