Kratom Overdose Mimicked Heart Attack, Causing Multi-Organ Failure in 38-Year-Old — Buprenorphine Led to Full Recovery

Why it matters

This case report documents how kratom intoxication — possibly compounded by an SSRI interaction — can cause life-threatening multi-organ failure that mimics a heart attack, and that physicians unfamiliar with kratom may not identify it as the cause. It also provides a successful treatment roadmap using buprenorphine-naloxone.

The big picture

Kratom is undetectable on standard urine drug screens, creating a dangerous diagnostic blind spot in emergency settings. This case illustrates why emergency and critical care physicians need kratom awareness — and how patients who develop kratom use disorder can recover fully with evidence-based treatment.

Key findings

• • A 38-year-old man using 7–14g of kratom daily (purchased from the dark web) presented with acute chest pain, confusion, and multi-organ failure — initially misdiagnosed as myocardial infarction
• • Lab findings on admission: LDH >2,500, ALT 2,945 units/L (severe liver injury), creatinine 677 µmol/L (acute kidney injury), troponin elevated, and CK 17,146 (rhabdomyolysis)
• • Kratom overdose, possibly complicated by SSRI co-use, was ultimately identified as the unifying diagnosis after addiction medicine consultation
• • Kratom is not detected on standard urine toxicology immunoassays — only GC-MS or LC-MS/MS can identify kratom metabolites
• • Patient recovered fully after 14 days, was started on buprenorphine-naloxone, and reported total abstinence and improved quality of life at 6-month follow-up

What they say

Single case report; University of Calgary and BC Centre on Substance Use; Psychiatry Research Case Reports, 2023.

Bottom line

This case is a warning to clinicians: kratom overdose can look exactly like a cardiac emergency, and standard drug screens will miss it — underscoring the need for explicit kratom questioning in substance use histories.