Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

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


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: 01-06-2019

Copyright Statement:  Copyright © 2019; The Author(s).


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.

PDF Share
  1. Singh D, Muller CP, Vicknasingam BK. Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug Alcohol Depend. 2014;139:132–137. doi: 10.1016/j. drugalcdep.2014.03.017.
  2. Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Selftreatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction. 2008;103:1048–1050. doi: 10.1111/j.1360- 0443.2008.02209.x.
  3. Cinosi E, Martinotti G, Simonato P, Singh D, Demetrovics Z, Roman- Urrestarazu A, et al. Following “the roots” of kratom (Mitragyna speciosa): the evolution of an enhancer from a traditional use to increase work and productivity in southeast Asia to a recreational psychoactive drug in western countries. BioMed Res Int. 2015;2015:968786. doi: 10.1155/2015/968786.
  4. Prozialeck WC. Update on the pharmacology and legal status of kratom. J Am Osteopath Assoc. 2016;116:802–809. doi: 10.7556/ jaoa.2016.156.
  5. Varadi A, Marrone GF, Palmer TC, Narayan A, Szabo MR, Le Rouzic V, et al. Mitragynine/corynantheidine pseudoindoxyls as opioid analgesics with mu agonism and delta antagonism, which do not recruit beta-arrestin-2. J Med Chem. 2016;59:8381–8397. doi: 10.1021/ acs.jmedchem.6b00748
  6. Galbis-Reig D. A case report of kratom addiction and withdrawal. WMJ. 2016;115:49–52.
  7. Anwar M, Law R, Schier J. Notes from the field. kratom (Mitragyna speciosa) exposures reported to poison centers — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65:748–749. doi: 10.15585/mmwr.mm6529a4.
  8. Dorman C, Wong M, Khan A. Cholestatic hepatitis from prolonged kratom use: a case report. Hepatology. 2015;61:1086–1087. doi: 10.1002/hep.27612.
  9. Kapp FG, Maurer HH, Auwarter V, Winkelmann M, Hermanns-Clausen M. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J Med Toxicol. 2011;7:227–231. doi: 10.1007/ s13181-011-0155-5.
  10. Nelsen JL, Lapoint J, Hodgman MJ, Aldous KM. Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure. J Med Toxicol. 2010;6:424–426. doi: 10.1007/s13181-010-0079-5.
  11. McIntyre IM, Trochta A, Stolberg S, Campman SC. Mitragynine ‘kratom’ related fatality: a case report with postmortem concentrations. J Anal Toxicol. 2015;39:152–155. doi: 10.1093/jat/bku137.
  12. Karinen R, Fosen JT, Rogde S, Vindenes V. An accidental poisoning with mitragynine. Forensic Sci Int. 2014;245:e29-e32. doi: 10.1016/j. forsciint.2014.10.025.
  13. Holler JM, Vorce SP, McDonough-Bender PC, Magluilo J, Solomon CJ, Levine B. A drug toxicity death involving propylhexedrine and mitragynine. J Anal Toxicol. 2011;35:54–59.
  14. Becker KL, Snider R, Nylen ES. Procalcitonin assay in systemic inflammation, infection, and sepsis: clinical utility and limitations. Crit Care Med. 2008;36:941–952. doi: 10.1097/CCM.0B013E318165BABB.
  15. Wacker C, Prkno A, Brunkhorst FM, Schlattmann P. Procalcitonin as a diagnostic marker for sepsis: a systematic review and metaanalysis. Lancet Infect Dis. 2013;13:426–435. doi: 10.1016/S1473- 3099(12)70323-7
  16. Lovas A, Ágoston Z, Késmárky K, Hankovszky P, Molnár Z. Extreme procalcitonin elevation without proven bacterial infection related to amphetamine abuse. Case Rep Crit Care. 2014;2014:179313. doi: 10.1155/2014/179313.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.