Toxicology of nutmeg abuse

Background: Unpleasant and frightening side effects associated with the abu se of nutmeg occasionally generate emergency department referrals, We repor t a young patient's first-time experience with nutmeg and review the mechan isms 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. T o facilitate ingestion, the nutmeg was put into 00-000 gelatin capsules. Bi zarre behavior and visual, auditory, and tactile hallucinations developed. She also experienced nausea, gagging, hot/cold sensations, and blurred visi on followed by numbness, double, and "triple" vision, headache, and drowsin ess. Nystagmus, muscle weakness, and ataxia were present, Her vital signs a nd laboratory tests mere normal. She received 50 g of activated charcoal an d except for complaints of dizziness and visual changes, her 2-day admissio n was uneventful. The central nervous system activity of nutmeg is often po stulated to result from biotransformation of its chemical components to amp hetamine-like compounds, but this has not been proven. Nutmeg contains seve ral compounds with structural similarities to substances with known central nervous system neuromodulatory activity.