Abstract Mitragyna speciosa, commonly referred to as “Kratom”, is a non-FDA regulated supplement used recreationally for its opiate-adjacent properties. Although not formulated or dispensed by pharmaceutical companies, its use has been increasingly prevalent in the United States, even resulting in an FDA statement regarding its risk to public health. Here we describe a case of a healthy young male who presented after cardiac arrest with multi-system organ failure presumed to be from Kratom use. A 35-year-old male with no past medical history presented to the emergency department after being found down by his significant other. Despite naloxone administration, the patient’s cardiac arrest persisted with return of spontaneous circulation only being achieved after five rounds of advanced cardiovascular life support. In the emergency department, endotracheal intubation was performed, and the patient was discovered to have severe metabolic acidosis, acute kidney injury, and mild transaminitis. The patient was hypotensive refractory to fluid resuscitation and was initiated on multiple vasopressors and admitted to the medical ICU. Transthoracic echocardiogram revealed no wall motion abnormalities, valvular conditions, or evidence of right or left ventricular failure. There was no family history of sudden cardiac death and the patient’s significant other only noted recent Kratom use prior to being found. The patient’s hemodynamics precluded the patient from undergoing further imaging. Ultimately, the patient’s hemodynamic status continued to worsen despite heroic efforts made by the medical team, and the family decided elected to pursue comfort care. The patient was pronounced deceased 16 hours after initial EMS contact. Kratom, also known as Mitragyna speciosa, is a naturally derived opiate-like supplement that originates from Southeast Asia. Multiple case reports discuss the fatality of this medication, often in combination with other CNS depressants such as opiates or psychiatric medications. There is an overall lack of understanding of the potential side effects of Kratom given the lack of regulation and formal pharmacological studies. It is hypothesized, however, that CNS depression results in reduced respiratory drive, hypoxia, and cardiopulmonary compromise. In the case described above, toxicology analysis was unable to be performed, however the utilization of naloxone suggests a lack of concomitant opiate overdose. With its increasing recreational use in the United States, Kratom is an important intoxicant to consider in patients presenting with cardiac arrest of unclear etiology. This abstract is funded by: None
Farrell et al. (Fri,) studied this question.