Fatal 4x100; Home-Made Kratom Juice Cocktail

Abstract

A corpse of 21-years-old man (Muslim) was investigated for the cause of death. His family declined consent for full autopsy. Thus, only blood and urine were used for toxicological analysis by liquid chromatography-electrosray ionization-time of flight mass spectrometry. These following substances were found in the blood and urine samples: mitragynine (an alkaloid found in Kratom; Mitragyna speciosa leaves), caffeine, diphenhydramine, alprazolam, nortriptyline, methadone, tramadol, methamphetamine and some of their metabolites. The findings of this case suggested the possibility of polydrugs abuse calls “4x100”, a Kratom juice cocktail that has been popular in Southernmost provinces of Thailand. It is made from four major ingredients, boiled Kratom leaves, Cola soft drink, cough syrup and tranquilizers or mosquito coils. In this case, the cause of death might be due to multidrugs intoxication of the additive adverse effects especially CNS and respiratory depression.