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Mitragynine 'Kratom' related fatality: a case report with postmortem concentrations.

Iain M McIntyre¹, Amber Trochta², Susan Stolberg²

¹County of San Diego Medical Examiner's Office, 5570 Overland Ave., Suite 101, San Diego, CA 92123, USA iain.mcintyre@sdcounty.ca.gov.

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|December 18, 2014

Summary

This case report details a fatal overdose involving mitragynine (Kratom) in a young man with a history of substance abuse. Postmortem analysis confirmed mitragynine and other substances, highlighting potential toxicity risks.

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Area of Science:

Forensic Toxicology
Pharmacology

Background:

A young male with a history of alcohol abuse, depression, and prior overdose presented with fatal unresponsiveness.
Autopsy revealed pulmonary edema and congestion, with urinary retention.

Observation:

Postmortem toxicology screening identified mitragynine (Kratom) in peripheral blood.
Gas chromatography-mass spectrometry (GC-MS) confirmed mitragynine and quantified its concentrations in various biological samples.

Findings:

Mitragynine was detected in peripheral blood (0.23 mg/L), central blood (0.19 mg/L), liver (0.43 mg/kg), and urine (0.37 mg/L).
Therapeutic levels of venlafaxine, diphenhydramine, and mirtazapine were also present, along with minimal ethanol (0.02%).

Implications:

This case contributes to understanding mitragynine toxicity in postmortem cases.
The findings suggest a lack of significant mitragynine postmortem redistribution, aiding in interpretation of toxicological results.