Case reportNutmeg (myristicin) poisoning — report on a fatal case and a series of cases recorded by a poison information centre
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.
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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)
Therapeutical and pharmacological section: nutmeg poisoning
Proc. R. Soc. Med.
(1908)Possible implication of myristicin as a psychotropic substance
Nature
(1966)Nutmeg as a narcotic
Angew. Chem. Int. Ed.
(1971)- et al.
The pharmacology of myristicin: a contribution to the psychopharmacology of nutmeg
J. Neuropsychiatry
(1961) - et al.
Evidence of mono amine oxidase inhibition by myristicin and nutmeg
Proc. Soc. Exp. Biol. Med.
(1963) - 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)...
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2022, Journal of Chromatography ACitation 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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