Case report
Nutmeg (myristicin) poisoning — report on a fatal case and a series of cases recorded by a poison information centre

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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 μg/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 μg/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 μg/ml was measured 8 h after ingestion of two to three tablespoonful of nutmeg powder (approx. 14–21 g, or 280–420 mg/kg).

Introduction

A main reason for the early voyages of discovery was the search for new spices. In doing so, the Portuguese discovered the nutmeg tree (Myristicia fragrans) on the Banda Islands of Indonesia in 1512 [8], [13]. The importance of nutmeg seeds was driven forward by the Dutch [8]. Already in the middle Ages, nutmeg was used in medicine as a stimulant, carminative, narcotic and abortifacient [9]. Later it was used to control diarrhoea associated with medullary carcinoma of the thyroid and Crohn’s disease [6]. Its effect is attributed to the inhibition of prostaglandin activity in the intestine [15].

The first case of nutmeg poisoning was described in 1576 by Löbel who reported the ingestion of 10–12 nutmegs (approx. 70–84 g) by a pregnant English lady to induce inebriety [8]. Already since the crusades, nutmeg seeds had been used as a hallucinogen and unsuccessfully, also as an abortifacient [12], [8]. In recent literature, the majority of cases of nutmeg ingestion observed were in prisoners [8], college students [10], [12] and adolescents [7]. They abused nutmeg as a substitute narcotic drug [10]. But never before, the myristicin concentration in biological materials was measured in such cases.

Section snippets

Case history and autopsy findings

Because on autopsy of a 55-year-old woman, the cause of death could not be established, a toxicological-chemical examination of the biological material was ordered. HPLC studies to search for drugs revealed the presence of flunitrazepam. Despite the fact that the concentration of flunitrazepam in serum was in the toxic range, death could not be explained by this finding alone.

The target of the subsequent investigation was justified by the nutmeg-like smell of the stomach contents. Thus,

TLC and UV–VIS spectroscopy

A thin-layer chromatography screening using the Toxi-Lab A-System (DRG Instruments) showed positive results after detection with ‘Marquis’, UV–VIS and ‘Dragendorff’.

White particles indicating tablet residues were visible in the stomach contents and a brown pulpy compound was also recognised. A spicy odour resembling nutmeg was noticeable. A methanolic solution of nutmeg powder was produced. The UV–VIS spectrum showed maxima at 215 and 280 nm. HPLC was performed at 220 nm. Spectra and

Cases recorded by the Poison Information Centre, Erfurt

The Poison Information Centre in Erfurt is responsible for four German federal states with a population of approximately 12 million. During the 1994–1998 period, the centre received 40 073 calls, including 26 933 cases of poisoning (67.2%). In contrast to 1994 and 1995, when there were no calls relating to nutmeg, seven cases of nutmeg ingestion were reported to the centre during the 1996–1998 period. Except in one case (9578/98) there had been an abuse of nutmeg powder or seeds with the

Discussion

Reference data about blood or tissue concentrations of myristicin could not be found in the literature. This communication is the first report about identification and quantification of myristicin in samples of human origin.

Nutmeg contains 5–15% volatile oils, a mixture of alkyl benzene derivatives, terpenes and myristic acid. Myristicin, elemicin and safrole amount to 80% of the alkylbenzene derivatives. They are the toxicologically relevant components of the nutmeg seed [13] (Fig. 2).

References (15)

  • A.R. Cushy

    Therapeutical and pharmacological section: nutmeg poisoning

    Proc. R. Soc. Med.

    (1908)
  • A.T. Shulgin

    Possible implication of myristicin as a psychotropic substance

    Nature

    (1966)
  • D.A. Kalbhen

    Nutmeg as a narcotic

    Angew. Chem. Int. Ed.

    (1971)
  • E.B. Truitt et al.

    The pharmacology of myristicin: a contribution to the psychopharmacology of nutmeg

    J. Neuropsychiatry

    (1961)
  • E.B. Truitt et al.

    Evidence of mono amine oxidase inhibition by myristicin and nutmeg

    Proc. Soc. Exp. Biol. Med.

    (1963)
  • G.S. Venables et al.

    Nutmeg poisoning

    Br. Med. J.

    (1976)
  • I. Fras, J.J. Friedman, Hallucinogenic effects of nutmeg in adolescents, N. Y. State J. Med. (1969)...
There are more references available in the full text version of this article.

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    Citation Excerpt :

    Therefore, a sensitive determination method for myristicin is required to evaluate its concentration in blood samples and correlate with the possible adverse effects caused by nutmeg. Until now, high-performance thin-layer chromatography (HPTLC) [7,8], high-performance liquid chromatography-UV (HPLC-UV) [9–14], HPLC with fluorescence detection (HPLC-FL) [15], gas chromatography-flame ionization detector (GC-FID) [16], GC-mass spectrometry (GC-MS) [17–21] and liquid chromatography-MS (LC-MS) [22,23] have been reported to determine myristicin in food samples. However, the sensitivity of HTPLC and HPLC-UV is low and interference prone, which makes them unsuitable for trace myristicin analysis.

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