Abstract
Background
Kratom (Mitragyna speciosa), an evergreen tree native to Southeast Asia, contains alkaloids that cause both
stimulant and opioid-like effects. In the United States, its use continues to grow.
Kratom products, however, are unregulated and nonstandardized, and reports of adulteration
have been described previously.
Case Report
A 21-year-old African-American woman with a history of occasional headaches and self-treatment
with internet-purchased kratom presented to the emergency department with the chief
symptoms of nausea, vomiting, and left flank pain. Laboratory tests showed a markedly
elevated serum creatinine of 4.25 mg/dL (reference range 0.6–1.2 mg/dL) and proteinuria.
A computed tomography scan of the abdomen and pelvis was unrevealing. A standard urine
screen for drugs of abuse was positive for opiates. A confirmatory testing revealed
the presence of hydrocodone and morphine in the urine. Hydrocodone, morphine, and
mitragynine were identified in a sample of kratom leaves provided by the patient.
The patient's renal function improved with supportive care and normalized 1 month
post discharge after kratom discontinuation.
Why Should an Emergency Physician Be Aware of This?
Despite widespread use, relatively little is known about kratom's adverse effects,
particularly regarding its potential to cause renal insufficiency. This case illustrates
the vital importance of recognizing that adulteration of unregulated products is certainly
a possibility and clinicians may continue to see a rise in adverse effects, given
kratom's increasing popularity.
Keywords—
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Article info
Publication history
Published online: March 04, 2022
Accepted:
February 25,
2022
Received in revised form:
January 20,
2022
Received:
November 19,
2021
Identification
Copyright
© 2022 Published by Elsevier Inc.
