Cardiac arrest in a healthy young adult after kratom tea
35M had out-of-hospital arrest with no co-ingestants; transient LV systolic dysfunction and small hypoxic infarcts; ultimately recovered.
Kratom Case Reports
Peer-reviewed, real-world cases linked to Mitragyna speciosa (kratom). Each card contains a plain-English summary and a direct PDF link. Educational use only — not medical advice.
Cardiac
Ventricular Fibrillation & QT Prolongation with Kratom
44M suffered out-of-hospital VF arrest; ECG showed prolonged QT. Cath and MRI were normal; he received a subcutaneous ICD. Authors warn of potential proarrhythmic risk (especially with stimulants/caffeine).
Ventricular Fibrillation During Football — Kratom + Caffeine
18M collapsed in training with ventricular fibrillation; plasma mitragynine 98 ng/mL and caffeine present. Normal echo/CTA/CMR; ICD implanted for secondary prevention. Authors implicate synergy of kratom, energy drink, and exertion; caution against stimulant combinations.
Kratom Cardiotoxicity: Reversible Brugada Pattern + QTc Prolongation
25M ingesting ~84–100 g/day kratom presented with seizure-like syncope; ECG showed type-1 Brugada pattern (QRS 160 ms, QTc 654 ms) that normalized after abstinence and electrolyte repletion.
Death from Kratom Toxicity and the Possible Role of Intralipid
26-year-old male suffered cardiac arrest ~24 h after kratom ingestion. Temporary response to IV lipid emulsion (“lipid rescue”) before multi-organ failure. Authors propose cardiotoxic metabolites and discuss emergency treatment options.
Hepatic
Kratom: A “Dangerous Player” in the Opioid Crisis
32-year-old man with acute jaundice and cholestatic hepatitis after heavy kratom use. Viral, autoimmune, and metabolic causes excluded. Liver enzymes improved after discontinuation. Authors highlight kratom’s potential hepatotoxicity and misuse amid the opioid crisis.
Histologic Characterization of Kratom-Related Liver Injury
38-year-old man with dark urine and pruritus after kratom ingestion. Biopsy showed portal inflammation with eosinophils, bile duct damage, and canalicular cholestasis. First report detailing histopathology of kratom-induced liver injury.
Kratom cholestatic liver injury mimicking PBC
37F developed severe cholestatic hepatitis that histologically mimicked PBC; autoimmune markers negative. Improved rapidly after stopping kratom.
Kratom-induced cholestatic liver injury (biopsy-proven)
52M developed bilirubin 28.9 mg/dL after ~2 months of daily kratom. Biopsy: canalicular cholestasis & bile-duct injury. Improved with UDCA + cessation.
Drug-induced liver injury with positive rechallenge
47M developed mixed pattern DILI ~21 days after starting kratom; recurrence within 2 days on rechallenge confirmed causality (RUCAM high probability).
Kratom-Induced Acute Liver Injury (Cholestatic) — Call for Regulation
47M with jaundice/pruritus after 3 weeks of kratom; cholestatic pattern, improving off-product. Paper reviews rising DILI from herbal products and shows current U.S. patchwork legality.
Kratom-Induced Hepatitis (Biopsy-Proven)
23M developed bilirubin 34 mg/dL and ALP 220 IU/L after 14 days of high-dose kratom (30 g/day). Biopsy: canalicular cholestasis, perivenular necrosis, mixed portal inflammation.
Severe Jaundice & Life-Threatening Liver Failure — Reversed by Plasma Exchange
56M with cholestatic liver failure after kratom; Tbili peaked at 70.6 mg/dL. Four therapeutic plasma exchanges rapidly reduced bilirubin and improved clinical status.
Neurologic
Seizure and Coma Following Kratom Exposure
64M experienced generalized seizure and coma after kratom–Datura tea; first lab-confirmed seizure case; neuroexcitation suspected.
Reversible Ischemic MRI Changes Linked to Chronic Kratom Use
20s M with heavy kratom use; bilateral cytotoxic edema on DWI/ADC reversed at 2 months; suggests transient vasospasm/vasculitis.
Transient Paralysis After Kratom
39F sudden whole-body paralysis ~1h post-ingestion with intact awareness; workup negative; neuromuscular blockade mechanism proposed.
Psychiatric
Kratom-Induced Psychiatric Decompensation & Paranoid Delusions
35M with schizoaffective disorder presented with new paranoid delusions after escalating kratom use; symptoms persistent despite trials; stimulant-like effects suspected.
Self-Management of Depression/Anxiety with Kratom — Then Failure Under Stress
63M long-term daily use “failed” under stress; detox and switch to standard pharmacotherapy/psychotherapy; functional dependence without clear withdrawal.
Cannabis + Kratom–Induced Psychosis With Self-Amputation
31M substance-induced psychosis after cannabinoids + kratom; self-amputation; stabilized on antipsychotics; later reconstruction after abstinence.
Neonatal
Neonatal Abstinence Syndrome from Maternal Kratom Use
Term infant developed withdrawal (Finnegan >10) despite negative opioid tox screen; oral morphine taper. Screen for kratom in NAS workups.
Maternal and Neonatal Kratom Dependence & Withdrawal
Postpartum mother using large daily kratom doses developed dependency; newborn required NICU morphine; placental transfer documented.
Neonatal abstinence syndrome from maternal kratom
Term infant Finnegan 18; required oral morphine for ~2 months; emphasizes detailed maternal supplement history.
Dermatology
Kratom-Induced Photo-Exposed Hyperpigmentation
32M with blue-gray facial/neck hyperpigmentation after long-term kratom; biopsy: melanin-laden histiocytes; fades after cessation.
Picosecond Laser Therapy for Kratom-Induced Hyperpigmentation
Two cases; 730 nm picosecond titanium-sapphire laser achieved >90% clearance without recurrence.
Forensic / Overdose
Fatal mitragynine toxicity (Canada)
56F with postmortem mitragynine 2,500 ng/mL — independently lethal; demonstrates kratom-only lethality at high dose.
Teen overdose from kratom capsules
15F ingested ~225 g capsules; nausea, tremor, hypokalemia, QTc 474 ms; resolved in ~14 h with supportive care.
Undifferentiated shock with extreme procalcitonin
18M in shock with PCT >200 ng/mL; cultures negative; improved with pressors — overdose/tox effect suspected.
Kratom Ingestion → Shock, Severe Acidosis, Intubation
35M apneic with mixed shock; RSI, dual pressors, hemodialysis; extubated and discharged after 72 h.
Rhabdomyolysis in Designer Benzodiazepine Misuse (Kratom Present)
26M with flubromazolam/clonazolam overdose, CK 131,920 U/L and AKI; kratom present among belongings.
Withdrawal / Treatment
Kratom Addiction and Withdrawal
37F dependent on kratom extract; severe opioid-like withdrawal; clonidine/hydroxyzine effective.
The Complexities of Kratom — Hospital Case with Successful Buprenorphine
72M developed in-hospital kratom withdrawal; controlled with buprenorphine-naloxone 8/2 mg daily; interaction cautions noted.
Drug Interactions & Other
Transaminitis; Naltrexone Triggered Opioid-Like Withdrawal
38M chronic kratom user with marked transaminitis; experienced classic precipitated withdrawal after IM naltrexone. Consider test dosing.
Adverse Drug Interaction: Kratom + Amitriptyline
37M on amitriptyline developed anticholinergic effects and mild transaminitis while using kratom; improved after stopping kratom; CYP2D6 inhibition suspected.
Serotonin Syndrome After Paxlovid in Patient Using Buspirone, Quetiapine & Kratom
Early-40s F developed SS two days after starting Paxlovid while on buspirone, quetiapine, and daily kratom; improved with lorazepam. Highlights ritonavir CYP3A inhibition.
Severe Withdrawal After Naltrexone in Undisclosed Kratom User
56M started oral naltrexone 50 mg; acute agitation/hallucinations; required dexmedetomidine and IV benzodiazepines. Screen for kratom prior to antagonists.
Hyperkalemia Induced by Kratom
61M persistent K⁺ > 5.5 mmol/L; normalized after stopping kratom. First reported kratom-induced hyperkalemia.
Life-Threatening Hyponatremia from Chronic Kratom Use
62M presented with Na⁺ 103 mEq/L; controlled saline correction + cessation; mechanism likely ADH/κ-receptor effects.
Kratom Adulterated with Phenylethylamine — Intracerebral Hemorrhage
54M switched products, developed large ICH; product contained ~15% PEA — not listed on label. Illustrates risk of adulterants.