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Toxicity and fatalities related to kratom use have increased substantially in recent years. In this case report, we describe a 44\u2010year\u2010old man who was found deceased in bed. The only significant finding at autopsy was abdominal distension with &gt;4\u2009L of ascites. Toxicology testing was performed on femoral blood which showed 79\u2009ng\/mL of hydromorphone, 560\u2009ng\/mL of mitragynine, and 240\u2009ng\/mL of olanzapine. In addition, creatinine and urea in vitreous humor were significantly elevated, consistent with renal impairment. Death was attributed to hydromorphone toxicity with mitragynine being a contributing factor.<\/jats:p>","DOI":"10.1111\/1556-4029.15394","type":"journal-article","created":{"date-parts":[[2023,9,27]],"date-time":"2023-09-27T10:36:06Z","timestamp":1695810966000},"page":"355-358","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A case of fatal overdose involving both hydromorphone and kratom"],"prefix":"10.1111","volume":"69","author":[{"given":"Thomas","family":"Shi","sequence":"first","affiliation":[{"name":"Department of Laboratory Medicine Dr. Everett Chalmers Hospital, Horizon Health Network  Fredericton New Brunswick Canada"},{"name":"Department of Pathology Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Shea","sequence":"additional","affiliation":[{"name":"Department of Pathology Dalhousie University  Halifax Nova Scotia Canada"},{"name":"Department of Laboratory Medicine Saint John Regional Hospital, Horizon Health Network  Saint John New Brunswick Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,9,27]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40122\u2010020\u201000151\u2010x"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.2147\/DDDT.S79658"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.7556\/jaoa.2012.112.12.792"},{"key":"e_1_2_8_5_1","unstructured":"Kratom (Mitragyna speciosakorth).https:\/\/www.deadiversion.usdoj.gov\/drug_chem_info\/kratom.pdf. 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