Citation

Shi T, Shea JL. J. Forensic Sci. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Society for Testing and Materials, Publisher John Wiley and Sons)

DOI

10.1111/1556-4029.15394

PMID

37753815

Abstract

Kratom is a plant originating in Southeast Asia that has been used for its dose-dependent stimulant and opioid effects. The main active compound in kratom is mitragynine, an alkaloid with affinity for the mu-opioid receptor. Toxicity and fatalities related to kratom use have increased substantially in recent years. In this case report, we describe a 44-year-old man who was found deceased in bed. The only significant finding at autopsy was abdominal distension with >4 L of ascites. Toxicology testing was performed on femoral blood which showed 79 ng/mL of hydromorphone, 560 ng/mL of mitragynine, and 240 ng/mL of olanzapine. In addition, creatinine and urea in vitreous humor were significantly elevated, consistent with renal impairment. Death was attributed to hydromorphone toxicity with mitragynine being a contributing factor.

Language: en

Keywords

kratom; mitragynine; forensic toxicology; herbal supplement; hydromorphone; renal insufficiency