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VOLUME 23 , ISSUE 5 ( May, 2019 ) > List of Articles

CASE REPORT

Undifferentiated Shock and Extreme Elevation of Procalcitonin Related to Kratom Use

Muhammad Zuberi, Pramod Kumar Guru, Vikas Bansal, Jose Diaz-Gomez, Beth Grieninger, David Alejos

Keywords : Kratom, Procalcitonin, Vasopressors

Citation Information : Zuberi M, Guru PK, Bansal V, Diaz-Gomez J, Grieninger B, Alejos D. Undifferentiated Shock and Extreme Elevation of Procalcitonin Related to Kratom Use. Indian J Crit Care Med 2019; 23 (5):239-241.

DOI: 10.5005/jp-journals-10071-23170

License: CC BY-NC 4.0

Published Online: 00-05-2019

Copyright Statement:  Copyright © 2019; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

An 18-year-old male with history of polysubstance abuse presented to the emergency department with intractable vomiting, diarrhea, and abdominal pain for one day after the consumption of kratom. Examination revealed arterial hypotension, tachycardia, and prolonged capillary refill. Laboratory studies showed white blood cell count (WBC) of 23.6 x 109/L, serum creatinine 4.0 mg/dL, lactate 6 mmol/L, and procalcitonin >200 ng/mL. Urine and blood drug screen were unremarkable. Radiology and echocardiogram were noncontributory. He received fluid resuscitation and broad spectrum antibiotics. Vasopressors were subsequently added to manage persistent shock. He remained afebrile, and his blood cultures were negative. His shock and associated organ dysfunctions improved over the next 72 hours. On discharge, his procalcitonin level decreased to 9.55 ng/mL, leukocytosis resolved, and the creatinine returned to baseline. This case describes an extremely rare presentation related to kratom, an herb marketed as an opioid alternative, with significant potential for addiction and withdrawal syndrome.


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