Kratom is a mixture of compounds that are present in the leaves of the tropical tree Mitragyna speciosa. It is used as a psychoactive agent with both opiate and stimulant-like effects. In this case series we describe the signs, symptoms, and the management of kratom overdose in the prehospital setting and in intensive care. We retrospectively searched for cases in the Czech Republic. Over 36 months we found 10 cases of kratom poisoning, which healthcare records were analyzed and reported as per CARE guidelines. The dominant symptoms in our series were neurological and included quantitative (n = 9) or qualitative (n = 4) disorder of consciousness. Signs and symptoms of vegetative instability [hypertension (n = 3) and tachycardia (n = 3) vs. bradycardia/cardiac arrest (n = 2), mydriasis (n = 2) vs. miosis (n = 3)] were noticed. Prompt response to naloxone in two cases and lack of response in one patient were observed. All patients survived and the effect of intoxication wore off within two days. Kratom overdose toxidrome is variable and, in keeping with its receptor physiology, consists of signs and symptoms of opioid-like overdose, sympathetic overactivation and serotonin-like syndrome. Naloxone can help to avoid intubation in some cases.

Department of Anesthesia and Intensive Care Medicine Charles University 3rd Faculty of Medicine and FNKV University Hospital Prague Czech Republic

Emergency Medical Services of the Karlovy Vary Region Karlovy Vary Czech Republic; Department of Anesthesia and Intensive Care Medicine Charles University 3rd Faculty of Medicine and FNKV University Hospital Prague Czech Republic

Emergency Medical Services of the Moravian Silesian Region Ostrava Czech Republic

Emergency Medical Services of the South Moravian Region Brno Czech Republic; Emergency Department University Hospital Olomouc Olomouc Czech Republic

References provided by Crossref.org