Abuse of nutmeg seeds: Detectable by means of liquid chromatography-mass spectrometry techniques?

Numerous case reports of intoxications with nutmeg seeds (Myristica fragrans, Houtt.) can be found in literature often following their abuse, as psychotropic effects were described after ingestions of large doses. The successful detection of the main ingredients of the nutmeg seeds essential oil elemicin, myristicin, and safrole, as well as their metabolites in human urine by gas chromatography coupled to mass spectrometry (GC-MS) was already described. The aim of this study was to investigate the detectability of the main ingredients of nutmeg seeds and their metabolites in human blood and urine samples using liquid chromatography coupled to linear ion trap mass spectrometry (LC-LIT-MSn ) and liquid chromatography coupled to high-resolution mass spectrometry (LC-HRMS/MS) after nutmeg seed abuse. Sample material of three individuals was retrospectively investigated after a systematic screening approach indicated an intoxication with nutmeg seeds as a likely cause of symptoms. Metabolic patterns in plasma and urine using GC-MS were comparable with those described in earlier publications. Investigations using hyphenated liquid chromatography techniques lead to the detection of myristicin and safrole, as well as further metabolites not described using GC-MS and revealed sulfation as an additional Phase II metabolic pathway. These results might help to detect or confirm future intoxications with nutmeg seeds by using LC-MS techniques.

Unintentional nutmeg autointoxication.

Nutmeg ingestion in large amounts can cause toxic symptoms such as hallucinations, tachycardia and anticholinergic effects. We describe a case of a 37-year-old woman who experienced an unintentional autointoxication of nutmeg. It is likely that nutmeg intoxication is underreported. We suggest to specifically think of nutmeg ingestion in case of symptoms as mentioned above.

Intoxicación grave por nuez moscada en polvo / Serious powdered nutmeg intoxication

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Myristicin and phenytoin toxicity in an infant.

A developmentally normal infant presented with repeated episodes of afebrile status epilepticus following nutmeg ingestion. He had developed two episodes of afebrile status epilepticus and had received different treatments earlier, but the details of treatment were not available. On admission, he redeveloped convulsions and loading doses of phenytoin, phenobarbitone and midazolam were administered. However, seizures persisted and extrapyramidal movements, nystagmus and visual dysfunction were noted. Iatrogenic phenytoin toxicity was considered and confirmed by drug levels. His symptoms completely disappeared after discontinuation of phenytoin therapy. The initial seizures were attributed to myristicin, an active component of nutmeg, because of the temporal association. However, the subsequent seizures were due to phenytoin toxicity caused by administration of multiple loading doses. This case highlights that nutmeg, a spice, can cause serious toxic effects like status epilepticus. Furthermore, treatment of status epilepticus with phenytoin can cause iatrogenic seizures due to its narrow therapeutic range.

Nutmeg poisonings: a retrospective review of 10 years experience from the Illinois Poison Center, 2001-2011.

Nutmeg is a commonly consumed spice. The toxic effects of nutmeg have been purported to be due mainly to myristicin oil. Prior poison center series of nutmeg exposures show very few unintentional exposures of nutmeg to children younger than 13. Case series from these centers did not record drug exposures combined with nutmeg. This study is a review of Illinois Poison Center (IPC) data regarding nutmeg exposures from January of 2001 to December 2011. The goal of this study was to compare the Illinois data to the literature as well as look for current trends in nutmeg poisonings. The data were extracted using the code for hallucinogenic plants in the IPC database, and poisonings unrelated to nutmeg exposure were eliminated. Medical outcomes were noted as recorded. Thirty-two cases of nutmeg ingestion were reported. Of the 17 (53.1 %) unintentional exposures, 10 subjects (58.8 %) were under the age of 13. Four of the exposures in children under the age of 13 were ocular exposures. Fifteen exposures (46.9 %) were intentional exposures. Of these intentional exposures, five (33.3 %) were recorded to have combined drug intoxication. All of these were between the ages of 15 and 20. One patient with polypharmaceutical exposure required ventilatory support in the hospital. Our study shows an unexpected percentage of unintentional exposures in juveniles under the age of 13, out of the total exposures to nutmeg. Mixing of nutmeg with other drugs was seen and required more intervention in adolescents. More education about these two factors, i.e., nutmeg exposures as intentional polypharmacy in adolescents and unintentional exposures in young children, is advised.

[Acute intoxication with nutmeg used as a recreational purpose--a case report]. / Ostre zatrucie galka muszkatolowa stosowana w celach rekreacyjnych--opis przypadku.

We present a case of acute nutmeg poisoning used for recreational purposes. Poisoning had a stormy clinical course with symptoms of gastrointestinal, cardiovascular and nervous system. The widespread availability of nutmeg suggests that real number of these poisonings may be underestimated in our country.

The spice of life: an analysis of nutmeg exposures in California.

BACKGROUND: Nutmeg is widely used as a household spice. Numerous citations in the medical literature report its abuse as a psychoactive agent, primarily for its purported hallucinogenic effects that are thought to be due to the compound myristicin; these are primarily limited to case reports. METHODS: We performed a retrospective review of the California Poison Control System database for the years 1997-2008 for all cases of single-substance human exposure to nutmeg. RESULTS: There were a total of 119 single-substance exposures to nutmeg. Eighty-six (72.3%) exposures were intentional. Patients intentionally abusing nutmeg were more likely to be between the ages of 13 and 20 than those with unintentional exposure to the spice (80.2% vs. 9.1%, p < 0.05). Abusers were significantly more likely to require medical evaluation than nonabusers (61.6% vs. 33.3%, p < 0.05). Patients who abused nutmeg were significantly more likely (p < 0.05) to experience tachycardia and agitation than those whose exposure was unintentional. No major effects and no deaths were reported to occur in either group. CONCLUSIONS: Although nutmeg exposure is uncommonly encountered, clinical effects from ingestion can be significant and can require medical intervention. While clinically significant effects were common, life-threatening toxicity and death did not occur in this series.

Intoxicación aguda por nuez moscada / No disponible

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Nutmeg intoxication in Texas, 1998-2004.

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.

Low cost, high risk: accidental nutmeg intoxication.

Nutmeg poisoning is rare but probably underreported and should be considered in recreational substance users with acute psychotic symptoms as well as central nervous system neuromodulatory signs that may mimic in part an anticholinergic hyperstimulation.

Acute nutmeg poisoning.

We present a case of acute nutmeg poisoning in a 16-year-old youth who had ingested the substance for recreational purposes. He developed a number of neurological symptoms and signs along with non-specific electrocardiographic changes and anti-cholinergic-type symptoms. We describe the pharmacology of nutmeg and its constituents, discuss its metabolism, and make recommendations about the management of nutmeg poisoning. Emergency staff should be aware of the effects of nutmeg, which may present in marijuana users who seek alternative substances.