The Not-so-Nice Spice A Teenage Girl With Palpitations and Dry Mouth

Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Pediatric emergency care (Impact Factor: 1.05). 12/2011; 27(12):1205-7. DOI: 10.1097/PEC.0b013e31823b26fa
Source: PubMed
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    ABSTRACT: In literature, cases of nutmeg abuse have been described repeatedly, but only one fatal case of poisoning was reported [1]. In the present case, myristicin (4 microg/ml) was detected for the first time in the postmortal serum of a 55-year-old woman. Identification was achieved with the aid of UV-VIS spectroscopy and TLC; for quantification, HPLC was used. Because also flunitrazepam (0.072 microg/ml) was found, death had probably been due to the combined toxic effect of both substances. From 1996 to 1998, in a series of cases, seven poisonings with nutmeg were recorded by the Erfurt Poison Information Centre. Even where higher doses (20-80 g of powder) had been ingested, a life-threatening situation was never observed. In one of these cases, a myristicin blood level of 2 microg/ml was measured 8h after ingestion of two to three tablespoonful of nutmeg powder (approx. 14-21 g, or 280-420 mg/kg).
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    ABSTRACT: Nutmeg is a spice that contains volatile oils comprised of alkyl benzene derivatives (myristicin, elemicin, safrole, etc.), terpenes and myristic acid. Nutmeg has a long history of abuse. This study describes the nutmeg ingestion calls received by Texas poison centers from 1998 to 2004. There were 17 calls involving nutmeg ingestion, of which 64.7% involved intentional abuse. When abuse and non-abuse ingestions were compared, abuse ingestions were more likely to involve males (100 versus 66.7%) and adolescents (55.6 versus 16.7%). The majority of both abuse and non-abuse calls were managed outside of health care facilities (54.5 and 66.7%, respectively). None of the ingestions resulted in more than moderate clinical effects or death.
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    ABSTRACT: BACKGROUND: Unpleasant and frightening side effects associated with the abuse of nutmeg occasionally generate emergency department referrals. We report a young patient's first-time experience with nutmeg and review the mechanisms of its toxicity. CASE REPORT: A 13-year-old female ingested 15-24 g of nutmeg over a 3-hour period and smoked and shared 2 joints of marijuana. To facilitate ingestion, the nutmeg was put into 00-000 gelatin capsules. Bizarre behavior and visual, auditory, and tactile hallucinations developed. She also experienced nausea, gagging, hot/cold sensations, and blurred vision followed by numbness, double, and "triple" vision, headache, and drowsiness. Nystagmus, muscle weakness, and ataxia were present. Her vital signs and laboratory tests were normal. She received 50 g of activated charcoal and except for complaints of dizziness and visual changes, her 2-day admission was uneventful. The central nervous system activity of nutmeg is often postulated to result from biotransformation of its chemical components to amphetamine-like compounds, but this has not been proven. Nutmeg contains several compounds with structural similarities to substances with known central nervous system neuromodulatory activity.
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