SHM Converge Scientific Abstract ePoster Gallery-Kratom Induced Manganese Toxicity

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A 52-year-old woman with COPD, chronic pain, and psychiatric comorbidities was admitted with acute hypoxic respiratory failure and septic shock from Streptococcus pneumoniae pneumonia complicated by empyema. She required prolonged intubation and later tracheostomy because repeated weaning and extubation attempts failed due to rigidity, dystonia, and agitation that initially raised concern for a movement disorder.<br /><br />During sedation breaks, her abnormal movements persisted. EEG was negative for seizures, but brain MRI showed bilateral basal ganglia T1 hyperintensity, a pattern suggestive of manganese deposition. A detailed social history revealed daily kratom use at an extremely high dose (about 100 g/day for 1 year). Laboratory testing showed markedly elevated serum manganese (86.6 ng/mL; normal 0.5–1.2), and product analysis confirmed manganese contamination in the kratom (2.93 mg/g). Her estimated manganese exposure far exceeded FDA-recommended intake.<br /><br />The authors conclude that this was likely kratom-induced manganese toxicity causing basal ganglia injury and parkinsonian features, which probably did not directly cause her respiratory failure but likely delayed neurologic recovery and complicated ventilator weaning. Chelation or neuroprotective treatment was not pursued because evidence for benefit is limited and the patient was clinically unstable. She improved enough for discharge, but residual tremor, dystonia, and gait instability remained, suggesting possibly irreversible neurologic damage.<br /><br />This case is presented as the first reported example of manganese toxicity from kratom and highlights the importance of careful neurologic examination, MRI interpretation, and thorough substance-use history in patients with unexplained movement disorders. It also underscores the risks of unregulated herbal supplements and the need for greater awareness and regulation of kratom-related heavy metal contamination.

Asset Subtitle

Mary Zahnle

Meta Tag

Author List Douglas Summerfield, I. Slater Alden, Mary Zahnle

Category Clinical Vignettes

Concept Kratom

Concept Manganese Toxicity

Concept Manganese Contamination

Concept Heavy Metal Toxicity

Concept Basal Ganglia Injury

Distinguished Non-Finalist

Presenter Organization MercyOne North Iowa

Presenting Author Mary Zahnle

Track Adult

Keywords

kratom toxicity

manganese poisoning

basal ganglia injury

parkinsonian features

dystonia

tremor

ventilator weaning failure

respiratory failure

heavy metal contamination

Streptococcus pneumoniae pneumonia

Kratom

Manganese Toxicity

Manganese Contamination

Heavy Metal Toxicity

Basal Ganglia Injury