Nutmeg Poisoning: The Hidden Dangers of a Common Spice

Nutmeg Toxicity: Risks, Symptoms, and Emerging Concerns

Nutmeg, a common kitchen spice, has a hidden dark side—its potential to cause toxic delirium when consumed in large amounts. While typically used in small culinary doses, excessive intake can lead to dangerous psychoactive effects. In recent years, nutmeg intoxication cases have surged, particularly after a viral social media challenge in April 2020 encouraged individuals to consume large quantities of powdered nutmeg mixed with water.

This blog aims to raise awareness about the dangers of nutmeg intoxication, outlining its symptoms, toxicology, and management strategies. Understanding the risks associated with excessive nutmeg consumption can help individuals make informed decisions and enable healthcare professionals to recognize and treat cases effectively.

Nutmeg toxicity presents with symptoms that closely mimic anticholinergic toxidrome, complicating diagnosis and treatment. The earliest documented case of nutmeg poisoning dates back to 1576, with modern reports emerging in 1908. Symptoms include mydriasis, burning abdominal pain, anxiety, psychotic episodes, visual hallucinations, dry mouth, cutaneous flushing, tachycardia, blurred vision, and urinary retention. Given the similarity of these symptoms to other toxic syndromes, clinical suspicion, and thorough patient history are critical in diagnosing nutmeg intoxication.

Clinical Manifestations of Nutmeg Intoxication

Nutmeg toxicity affects multiple organ systems, with symptoms including:

• Central Nervous System: Agitation, hallucinations, drowsiness, dizziness, blurred vision

• Gastrointestinal: Nausea, vomiting, diarrhea

• Cardiovascular: Tachycardia, hypertension, hypotension

• Autonomic Symptoms: Dry mouth, urinary retention, cutaneous flushing

Sinus tachycardia is the most consistent abnormal finding. Because no specific diagnostic test exists, nutmeg intoxication remains a clinical diagnosis based on history and symptomatology.

Nutmeg intoxication can lead to significant anticholinergic effects, making diagnosis challenging due to its overlap with other toxic syndromes. Patients may present with dry mouth, urinary retention, mydriasis, cutaneous flushing, and blurred vision, symptoms commonly seen in classic anticholinergic poisoning. Additionally, sinus tachycardia and altered mental status are hallmark findings, further complicating clinical assessment.

Beyond its anticholinergic properties, nutmeg has been implicated in neurotoxicity, particularly at high doses. Compounds such as myristicin and elemicin may interfere with serotonergic and dopaminergic pathways, contributing to hallucinations, agitation, confusion, and psychotic episodes. Some reports also suggest nutmeg-induced seizures and tremors, indicating potential excitatory neurotoxicity. Given these effects, medical professionals should be aware of nutmeg-induced neurotoxicity in cases presenting with unexplained central nervous system disturbances.

Potential Risks and Complications of Nutmeg Toxicity

Beyond its psychoactive properties, nutmeg toxicity presents serious health risks, particularly nutmeg-induced neurotoxicity and cardiotoxicity. High doses of myristicin, elemicin, and safrole can contribute to nutmeg-induced tachycardia, hypertension, and even seizures. Patients may experience nutmeg-induced nausea, vomiting, abdominal pain, and dry mouth, mimicking anticholinergic effects seen in other toxic syndromes. Additionally, nutmeg-induced delirium, psychosis, confusion, and euphoria may further complicate diagnosis, making it essential for clinicians to maintain a high index of suspicion in cases of unexplained altered mental status.

The Pharmacology of Nutmeg Intoxication

Nutmeg contains several psychoactive compounds, including:

• Myristicin – Metabolized into 3,4-methylenedioxy-5-methoxyamphetamine (MMDA)

• Elemicin – Metabolized into 3,4,5-trimethoxyamphetamine (TMA)

• Safrole – A known hepatotoxin

Although MMDA and TMA are structurally similar to amphetamines, their role in nutmeg toxicity remains unclear, as studies have failed to detect these derivatives in urine samples of intoxicated patients. Myristicin-N-acetyl-cysteine, a metabolite of myristicin, is cytotoxic, but its contribution to the clinical effects of nutmeg poisoning is still uncertain. Additionally, trimyristin, another compound in nutmeg, may interfere with serotonin receptor activity, exacerbating anxiety and hallucinations.

Toxic Dose and Fatal Cases

The minimum toxic dose of nutmeg is not well-defined. However:

• 5 g (~1-2 mg myristicin/kg body weight) has resulted in intoxication.

• 10 g (~2 teaspoons of powdered nutmeg) caused intoxication in all study participants.

• 14 g was lethal in an 8-year-old boy.

• A 55-year-old woman died with detectable myristicin levels post-mortem.

Management of Nutmeg Intoxication

Treatment for nutmeg poisoning is primarily supportive, with symptoms usually resolving within 24-48 hours. Key management steps include:

• Cardiopulmonary monitoring for potential arrhythmias or severe tachycardia

• Benzodiazepines for managing anxiety and agitation

• Activated charcoal (if ingestion is recent and the patient is alert)

·         Although fatalities are rare, nutmeg intoxication should be considered when evaluating patients with unexplained anticholinergic-like symptoms and unknown substance ingestion. Given nutmeg’s affordability and accessibility, along with its increasing popularity on social media as a recreational drug, medical professionals should remain vigilant in recognizing and managing cases of nutmeg toxicity.

Management and Prevention of Severe Nutmeg Toxicity Beyond its psychoactive properties, nutmeg toxicity presents serious health risks, particularly nutmeg-induced neurotoxicity and cardiotoxicity. High doses of myristicin, elemicin, and safrole can contribute to nutmeg-induced tachycardia, hypertension, and even seizures. Patients may experience nutmeg-induced nausea, vomiting, abdominal pain, and dry mouth, mimicking anticholinergic effects seen in other toxic syndromes. Additionally, nutmeg-induced delirium, psychosis, confusion, and euphoria may further complicate diagnosis, making it essential for clinicians to maintain a high index of suspicion in cases of unexplained altered mental status.

While fatalities are rare, severe toxicity has been associated with nutmeg-induced shock, hypotension, and even toxicity-related death in extreme cases. Given its widespread availability and affordability, nutmeg overdose remains an underrecognized yet potentially dangerous form of recreational substance misuse. Supportive care remains the cornerstone of treatment, including symptom management for nutmeg-induced toxicity symptoms such as tremors, agitation, and flushing. Although no specific nutmeg poisoning antidote exists, timely administration of activated charcoal and benzodiazepines for agitation can help mitigate severe effects. Raising public awareness and educating individuals on the side effects of nutmeg overdose may prevent unnecessary hospitalizations and long-term health complications.

Case Study of Nutmeg Poisoning

A 19-year-old male was brought to the ED in police custody due to aggressive behavior and suspected intoxication after biting another patron at a hotel bar. Upon arrival, he appeared calm and cooperative. A physical examination revealed:

• Tachycardia (129 bpm)

• Fever (101℉)

• Nystagmus

• Symmetrically dilated pupils with sluggish reactivity.

• Dry skin

• Forehead abrasion (no other trauma noted)

His electrocardiogram (ECG) showed sinus tachycardia with no concerning intervals. Aside from an elevated lactate level (6 mmol/L), initial laboratory tests were largely normal. The differential diagnosis included synthetic cannabinoids, mescaline, phenethylamines, polysubstance abuse, and central nervous system infections, warranting empirical antibiotics and a lumbar puncture.

Shortly after arrival, the patient became highly agitated, damaging medical equipment and resisting verbal de-escalation. Despite multiple intramuscular doses of haloperidol (5 mg) and lorazepam (2 mg), he remained uncontrollable, necessitating intubation for further management.

In the intensive care unit (ICU), he self-extubated the following day and later admitted to ingesting "a large amount" of nutmeg for its psychoactive effects, which his family confirmed. Poison Control recommended 24-hour monitoring and supportive care. He was discharged in stable condition after the resolution of symptoms.

Key Takeaways on Nutmeg Toxicity and Safety

Nutmeg intoxication, though uncommon, presents with symptoms that can mimic anticholinergic toxidrome, making early diagnosis challenging. Healthcare providers should be aware of this potential toxidrome, particularly in young patients presenting with hyperactive delirium, tachycardia, and hallucinations. With increasing social media influence, nutmeg misuse may continue to rise, emphasizing the importance of awareness and early intervention in emergency settings.

Nutmeg is a widely used spice with potential medicinal benefits, but excessive consumption can lead to toxicity, hallucinations, and organ damage. While small doses may benefit health, high doses should be avoided due to potential neurotoxic and cardiotoxic effects. By raising awareness of nutmeg intoxication, medical professionals can improve recognition, provide appropriate management, and prevent unnecessary interventions, ensuring better patient outcomes in cases of acute toxicity.

In summary, while nutmeg offers culinary and potential health benefits when used appropriately, excessive consumption poses significant health risks. Healthcare providers should maintain a high index of suspicion for nutmeg intoxication in patients presenting with relevant symptoms and provide timely management to prevent complications.

FAQs on Nutmeg Intoxication with Scientific References

How long do the effects of nutmeg intoxication last?

• Symptoms typically resolve within 24-48 hours

Is nutmeg poisoning common?

• While rare, cases have increased due to intentional misuse (Ehrenpreis et al., 2014).

Can nutmeg cause permanent damage?

• Most cases resolve without lasting effects, but severe toxicity can cause cardiac arrhythmias, seizures, or organ damage (Beckerman & Persaud, 2019).

What is the lethal dose of nutmeg?

• Lethal cases are rare, but doses exceeding 14 g have been fatal (Rahman, 2015).

Can nutmeg intoxication be treated at home?

• Mild cases may resolve with rest and hydration, but severe symptoms require medical care.

What is the antidote for nutmeg poisoning?

• There is no specific antidote; treatment includes supportive care, IV fluids, and activated charcoal (Beckerman & Persaud, 2019).

How to recover from nutmeg poisoning?

• Supportive care, hydration, and monitoring are crucial. Severe cases require hospitalization (Casale et al., 2023).

What does nutmeg poisoning look like?

• Symptoms include nausea, vomiting, dizziness, hallucinations, tachycardia (rapid heart rate), and confusion.

How many people have died from nutmeg poisoning?

• Only one documented fatal case, but severe toxicity cases requiring hospitalization exist .

Does nutmeg show up on a drug test?

• Yes, myristicin, elemicin, and safrole can be detected in urine via chromatography (Manier et al., 2021).

How much nutmeg is needed to get high?

• Psychoactive effects may occur with 5-30 g (1-3 seeds) (Carstairs & Cantrell, 2011).

What is the LD50 of nutmeg toxicity?

• The lethal dose (LD50) in rats is 5.1 g/kg (Rahman, 2015).

Can nutmeg be used safely?

• Yes, nutmeg is safe in small amounts (<1 teaspoon per day) (Gupta, 2020).

Is nutmeg a narcotic?

• Nutmeg contains myristicin, a psychoactive compound, but it is not classified as a narcotic.

Why is nutmeg prohibited in some regions?

• Some Islamic scholars classify it as haram in large doses (aliftaa.jo, 2024).

What does nutmeg do to your brain?

• Nutmeg affects the central nervous system, causing hallucinations and altered mental status (Shallal et al., 2019).

How does nutmeg affect the heart?

• High doses can cause tachycardia, palpitations, and hypertension (Casale et al., 2023).

Is nutmeg bad for the liver?

• Excessive consumption may cause liver damage (Cao et al., 2020).

What does nutmeg do for a woman?

• It is traditionally believed to enhance circulation and reproductive health (Gupta, 2020).

Does nutmeg detox your body?

• Nutmeg has been suggested for liver detoxification, but scientific evidence is limited (Xia et al., 2021).