Acute kidney injury associated with mitragynine toxicity: a case report

Abstract

Background: Ketum (Mitragyna speciosa) is easily found in Southeast Asia. It consists of primary alkaloids known as mitragynine, which result in effects similar opiods, and are also used for energy stimulant and pain relief in the form of Ketum cocktail drinks. The use of excessive Mitragyna speciosa leads to mitragynine toxicity. 

Case presentation: A 22-year-old man presented with agitation, incoherent speech, and multiple generalized tonic-clonic seizures, leading to unconsciousness. Upon ICU admission, he had normal vital signs but required intubation due to a GCS of 3/15. Laboratory results showed elevated creatinine kinase, creatinine, and urea levels, with positive urine mitragynine. The patient was diagnosed with status epilepticus secondary to mitragynine toxicity, meningoencephalitis, and acute kidney injury due to rhabdomyolysis. Treatment included mechanical ventilation, sedation, fluid management, and antibiotics. Despite initial improvement and extubation, the patient was readmitted to ICU with aspiration pneumonia, underwent CPR, and ultimately succumbed to the illness after six days of readmission.

Conclusion: Mitragynine toxicity can cause seizures, rhabdomyolysis, and acute kidney injury. Close monitoring post-ICU discharge is crucial.

Keywords: Acute kidney injury; Ketum; Mitragyna speciose

Citation: Muhammad F, Suhaimi FM, Mazlan MZ. Acute kidney injury associated with mitragynine toxicity: a case report. Anaesth. pain intensive care 2026;30(2):270-273. DOI: 10.35975/apic.v30i2.3137

Received: May 09, 2025; Revised: October 26, 2025; Accepted: January 01, 2026