Scientific Name
Myristica fragrans Houtt
Synonyms
Aruana silvestris Burm.f., Myristica aromatica Sw., Myristica aromatica Lam., Myristica moschata Thunb., Myristica officinalis L.f. , Palala fragrans (Houtt.) Kuntze [1]
Vernacular Name
| Malaysia | Pala, buah pala, bunga pala, pala laki-laki, kembang pala, pokok pala [2][3][4] |
| English | Nutmeg, common nutmeg, mace, nutmeg tree [2][3][5] |
| China | Jou kuo, jou tuo kou,rou dou kuo ,dza ta pha la, dza ti pa tra, dza tip ha la, dzali za ti (Tibet) [5] |
| India | Aiphol (Assam); jayphal (Bengal); jaipatri (Gujerat); jaiphal (Hindi); jakaya, jatipala (Kannada); jaiphar (Maithili); jathi, jathikka, jathikkayu, jathikosham (Malayalam); jayphal (Marathi); jaiphal (Nepal); jaiphala (Oriya); jaiphal (Punjab); jatiphala (Sanskrit); atipalam, jatikkai, jatippu (Tamil); jaiphal (Urdu) [5][6 ] |
| Indonesia | Pala, pala banda fuli, bumbu, sekar pala,bunga pala, kulit pala, kulumud pala [2][5] |
| Philippines | Duguan (Tagalog) [2][5] |
| Singapore | Pokok pala, buah pala [2][4][5] |
| Myanmar | Mutwinda [2][5] |
| Cambodia | Pôch kak [2][4][5] |
| Laos | Chan th’e:d [2][4] |
| Thailand | Chan-thet (Central); chan-ban (Northern); dok chan, dok chand nattes, luk chand [2][4][5] |
| Vietnam | Nh[ujlc d[aaj]u kh[aas]u [2][5] |
| Korea | Meisu, neotumek, yuktugu [4] |
| Japan | Mesu, natumegu, nikuzuku [4] |
| Nepal | Jaaiipatrii, jayaphal [4] |
| Norway | Muskut, muskatblomme, muskatnott (Norweigian); netmuskat (Papiemento) [4] |
| Sweden | Muskott,muskotnot, musotblomma [4] |
| Poland | Galka,muszkatolowa, muszkat, muszkatowiee [4] |
| France | Noix de muscade, fleur de muscade, macis, muscade, muscadier, muscadier commun, muscadier cultive, Noix de banda, noix de muscade, pied de muscade [2] [4] |
| Malta | Nucimuskata [4] |
| Lithuania | Kvapusis, muskatmedis, macis, muskatas, muskato, ziedai [4] |
| Latvia | Muskatrieksts [4] |
| Iran | Basbaz, djus, hendi, jouz hendi, jouzboyah (Persian) [4] |
| Brazil | Biciuba, flor de noz moscada, noz moscada [4] |
| Turkey | Besbase, cevz buva, industan djevisi [4] |
| Italy | Mace, noce moscata [4] |
| Portugal | Moscadeira, nuz moscada [4] |
| Romania | Frunzisoara, nucsoara [4] |
| Russia | Muskatnii orekh, muskatnvj orekh, muskatnyj tsvet, muskatnogo orekha, mushkatnoi drechi, sushonaya shelukha [4] |
| Slovakia | Muskatnovik vonavy, muskatovy kvet, muskatovy orech [4] |
| Slovenia | Muskat, muskatni cvet, muskatni oreseek [4] |
| Spain | Corteza de la nuez moscada, macia, macis, moscadero, moscado neuz moscada, nuez muscada, nogal moscado [4] |
| Saudi Arabia | Basbas, basbasah, fuljan, jawz at-tyib, josat al teeb, josat al-tib, jasat at-tib, jouza al-teeb, jouza at-teeb, jousbuva, jouzutib, jowz buwwa [4]. |
Geographical Distributions
Myristica fragrans probably originated from Indonesia [6] (from the Southern Moluccan Islands, particularly Ambon and Banda) [2] or east of Malaysia [7]. This plant is cultivated in other Indonesian islands, notably North Sulawesi, Sri Lanka, India (Kerala), Malaysia (Penang) [2] and New Guinea [3].
Botanical Description
M. fragrans is an evergreen tree from the family of Myristicaceae. It can grow up to 30 m in height with an undivided trunk. The plant is cone-shaped if it grows freely, exuding a sticky red sap when wounded. The twigs are slender, 1-2 mm in diametre towards the top. Smooth, greyish brown at the bark of the plant but green in colour when the branches are young. [2][9]
The leaves simple, alternate, papery structure, exstipulate, the blade elliptical to lanceolate, 5-15 cm x 3-7 cm, acute base, acuminate apex, entire margin, leathery and give out an aromatic smells when bruised. The petiole short, measures about 1 cm long. [2][9]
The inflorescence is in the form of axillary and in umbellate cymes. The flowers are fragrant, almost hairless with sparse, very minute tomentum present, pale yellow and with a 3-lobed perianth. Male and female flowers are normally borne on separate trees but there are also male and female flowers on the same tree. The male flower has a slender pedicel less than 1 mm thick with a narrowed perianth at the base, usually many-flowered, 8-12 stamens are adnate to a column. The inflorescence of the female tree contains 1-3 flowers with a white, bell-shaped perianth. The ovary is superior, 1-celled ending in 2-lobed stigma, normally anatropous to hemi-anatropous. [2][9]
The fruit almost round, drupe-like, fleshy, up to 8 cm long and 5 cm thick, acuminate at the end of stem, light yellow, splitting into two when ripe, exposing the bright red mace or aril which is surrounding the dark brown seed. The seed is ovoid, 1-seeded, 2-3 cm long, shiny dark brown in colour, hard and longitudinally wrinkled shell. [2][9]
Cultivation
No documentation.
Chemical Constituent
Ethanol extract of M. fragrans fruit has been reported to contain phenyl propanoid ethers (e.g. eugenol, isoeugenol, methyl eugenol and myristicin), fatty acid ester (e.g. trimyristin), phenolic acids (e.g. protocatechuic acid, caffeic acid and ferulic acid), flavonoids (e.g. catechin, quercetin, apigenin, kaempferol and isorhamnetin), fatty acid (myristic acid), and terpenoids (e.g. oleanolic acid and ursolic acid). [10]
Essential oil of M. fragrans has been reported to contain myristic acid, myristicin, safrole, β-pinene, terpinen-4-ol, α-pinene, γ-terpinene and β-phellandrene. [11][12]
Hexane extract from the hydrodistillation of essential oil of M. fragrans dried seed kernels has been reported to contain eugenol, methylisoeugenol, methylisoeugenol, elemicin, myristicin, safrole, (1R)-α-pinene, sabinene, β-pinene, α-myrcene, α-phellandrene, car-3-ene, isoterpinolene, o-cymene, γ-terpinene, (Z)-α-terpineol, terpinolene, (Z)-4-thujanol, linalool, β-terpinyl acetate, (E)-ρ-menth-2-en-1-ol, (Z)-1-methyl-4-(1-methylethyl)cyclohex-2-en-1-ol, terpinen-4-ol, α-terpineol, (Z)-piperitol, and α-cubebene. [13]
Methanol extract of M. fragrans aril (mace) has been reported to contain phenolic (e.g. fragransol A, fragransol B, fragransol C, dehydrodiisoeugenol, isoeugenol) and neolignans (e.g. 1-deoxycarinatone, isodihydrocarinatidin, isolicarin A, and (+)-dehydrodiisoeugenol) [14][15]. M. fragrans aril also has been reported to contain fragransol A, fragransol B, fragransin D1, fragransin D2, fragransin D3, fragransin E1 and austrobailignan-7 [16].
M. fragrans dried ripe seeds has been reported to contain neolignans (e.g. licarin B, 3’-methoxylicarin B, myrisfrageal A, isodihydrocainatidin, dehydrodiisoeugenol, myrisfrageal B, myrifralignan A–E, myrislignan, and machilin D) [16][17]. M. fragrans seeds also has been reported to contain phenolic compounds (e.g. ((7S)-8’-(benzo[3’,4’]dioxol-1’-yl)-7-hydroxypropyl)benzene-2,4-diol, ((7S)-8’-(4’-hydroxy-3’-methoxyphenyl)-7-hydroxypropyl)benzene-2,4-diol, ((8R,8’S)-7-(4-hydroxy-3-methoxyphenyl)-8’-methylbutan-8-yl)-3’-methoxybenzene-4’,5’-diol, erythro-(7S,8R)-7-(4-hydroxy-3-methoxypheny1)-8-[20-methoxy-4’-(E)-propenyl)phenoxy]propan-7-ol, malabaricone C, (+)-erythro-(7S,8R)-∆8-7-acetoxy-3,4,3’,5’-tetramethoxy-8-O-4’-neolignan, and (+)-erythro-(7S,8R)-∆8-7-hydroxy-3,4,3’,5’-tetramethoxy-8-O-4’-neolignan) [18].
Other constituents to be found from M. fragrans including lignans (e.g. machilin A, macelignan, machilin F, nectandrin B, safrole, licarin A, licarin B, myristargenol, and meso-dihydroguaiaretic acid). [19]
Plant Part Used
Flowers, seeds, leaves, arillus, fruits, and stems. [3][8][20]
Traditional Use
Traditionally, M. fragrans has been used to treat digestive disorders, such as nausea and diarrhoea and kidney ailments. Southeast Asians also treat their fevers, headaches and bronchial problems using nutmeg. The Chinese consider it to be aphrodisiac [7]. The decoction of the stem of M. fragrans is useful in arresting diarrhoea [20].
About two pinches of the fruit shall be taken twice daily with water or honey as a good appetiser, treat flatulence, strengthens the digestive system, acts as a tonic to heart and brain, improves sexual power, controls incontinence of urine and is a good tonic for general debility. In women it acts as general uterine tonic especially for excessive or painful menses [21]. The volatile oils present are digestive and carminative, and thereby a decoction of it is highly beneficial in such conditions. A cold infusion of its fruits quenches thirst as well as suppresses nausea and vomiting. Nutmeg paste added with some water aiding in getting rid of the spots or black discolourations on the face. This method also has been used for cracked soles, headache, arthritis and burning eye [20].
The seeds are considered an abortifacient and had been used in many European countries in the past including the Britain and the Germany. For cold, headache and cardiovascular cases, the decoctions of the seeds are used orally to reduce the symptoms [22]. Indians traditionally have treated stomach pains, dysentery, vomiting and the symptoms of malaria with mace. It is also chewed to prevent foul breath [7]. The outer shell of the nutmeg seeds is turned into powder form to treat flatulent dyspepsia in elderly. With a mixture of honey or banana, it serves as a carminative agent to the body [23]. Moroccan practitioners used the seeds as rectal suppository to treat haemorrhoids. The dried seeds also can be used as diuretic and therefore Brazilian to be used in the treatment of high blood pressure. Whilst Singaporean used hot water extract of the leaves to treat high blood pressure. It is also used as an emmenagogue and in cases of dysmenorrhoea. Roasted nutmeg is consumed orally to treat leucorrhoea. In India the leaves in combination with Vitex negundo, Mimosa pudica, Asparagus gonocladus, Cucumis melo, and Staryx officinalis evaporated in milk is used in sterility [9].
Besides the medicinal uses, M. fragrans or known as nutmeg has become a commercial product around the world. The dried shelled seed (nutmeg) and also dried arils (mace) are sold as spices. The mace is usually used in savoury dishes, pickles and sauces. The essential oil found from the seed, mace oil from the aril bark, leaf and also flower such as oleoresins is used in canning industry, soft drink and also in cosmetics industry. The nutmeg oil was extensively used in major food products, but the maximum permitted level in food is about 0.08%. The essential oil has an insecticidal, fungicidal and bactericidal activity. [2]
Preclinical Data
Pharmacology
Anticonvulsant activity
Essential oil of M. fragrans dried kernels of the ripe seeds (100, 200, 300 µL/kg) respectively administered intraperitoneally to male mice (20–30 g body weight) in 5 minutes before induction of seizures (using pentylenetetrazole (PTZ)) was compared to valproic acid (positive control). The results showed dose-related effects against different patterns of PTZ-induced seizures including protection from myoclonic twitch (200 µL/kg: 30% protection, 100 and 300 µL/kg: ineffective), threshold seizure and generalized clonic seizures with loss of the righting reflex (100 µL/kg: 70%, 200 µL/kg: 100%, 300 µL/kg: ineffective), loss of the righting reflex with tonic forelimb (100 and 200 µL/kg: 100%, 300 µL/kg: 60%), and tonic fore and hind limb seizures( 100 and 200 µL/kg: 100%, 300 µL/kg: 70%). Due to the anticonvulsant activity across many seizure models, M. fragrans may be important in grand mal and partial seizures. [24]
Liver microsomal induction activity
Volatile oil of M. fragrans (0.4, 0.8 and 1.2 mg/g) administered to mice twice a day for duration of 10 days were significantly (p < 0.01) increased the contents of liver microsomal cytochrome P450 (CYP), cytochrome b5 (Cytb5), MDA and GST in serum while the contents of MDA was significantly (p < 0.01) reduced. [25]
Essential oils of M. fragrans administered to Swiss albino mice at 10 μL/day for duration of 14 days significantly (p < 0.05) induced cytochrome P450 level. [26]
Hepatoprotective activity
Myristicin compound in the M. fragrans (50, 100, or 200 mg/kg) administered three hours before lipopolysaccharide/D-galactosamine (LPS/D-GaIN)-induced liver injury to six week old male ddY strain mice (30-36 g) for duration eight hours was found to have extraordinary hepatoprotective activity. It significantly (p < 0.05) inhibited the elevations of serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in a dose dependent manner and was markedly inhibited the LPS/D-GaIN-induced enhancement of serum TNF-alpha concentrations and hepatic DNA fragmentation in mice. [27]
Macelignan from aqueous methanol extract of M. fragrans dried seed kernels (25 and 50 mg/kg per day) administered with corn oil orally to cisplatin-induced hepatotoxicity in male ICR mice (20-30 g) for duration of four days significantly (p < 0.001) reduced ALT and AST compared to standard curcumin. Macelignan attenuated the expression of phosphorylated c-Jun in cisplatin-treated mice. [28]
Antidiarrhoeal activity
Hexane fraction of the ethanol extract of the fruit and flowers of M. fragrans was found to have the most antisecretory activity against Eschericia coli heat labile and heat stable enterotoxin. The fraction (300 mg/loop) inhibited toxin-induced secretory responses in the rabbit and guinea pig ileal loops. [29]
Anticancer activity
Methanol extract of M. fragrans (10, 50 and 100 μg/mL) significantly inhibited Jurkat human leukemia T cell line cell proliferation and induced apoptosis. There was a downregulation of the SIRT1 (Silent Information Regulator Two ortholog 1; it is one of the regulators of cell life span and is involved in aging-associated processes) mRNA expression in the Jurkat cells. [30]
Aqueous suspension of pulvarized M. fragrans mace (10 mg/day) administered orally to 3-methylcholanthrene (MCA)-induced carcinogenesis in the uterine cervix of virgin, young adult, Swiss albino mice for duration 7 days before and 90 days after carcinogen thread insertion showed a highly significant (p < 0.001) reduction in carcinoma incidence (21.4%) compared to animals exposed intracervically to MCA-plus-wax impregnated threads and treated with the vehicle as a control (73.9%). [31]
Memory enhancing activity
The n-hexane extract of M. fragrans (5, 10, 20 mg/kg) were administered orally to scopolamine-induced memory impairment (0.4 mg/kg intraperitoneal) and diazepam (1 mg/kg intraperitoneal) on young and aged mice for duration of three days. It was found that lowest dose of the extract significantly showed improvement in the learning and memory of both the young and aged mice. It had reversed the impairment induced by scopolamine and diazepam in young mice and it also enhanced the learning and retention capabilities of both young and aged mice. [32]
Hydroalcohol extract of M. fragrans showed significant anticholinesterase activity with 50% inhibition of acetylcholinesterase. [33]
Radioprotective activity
Ethanol extract of M. fragrans seeds (6, 8, 10 mg/kg body weight/day) administered orally to young male Swiss Albino mice (22 ± 2 gms) for duration of 3 days prior to irradiation and 30 days observation for survival showed significant elevation of hepatic glutathione (GSH) and alkaline phosphatase (ALP) whilst decreased testicular lipid peroxidation (LPO) level and acid phosphatase (ACP) in a dose dependent manner. [34]
Antimicrobial activity
Antibacterial
Malabaricon B and malabaricon C isolated from the M. fragrans mace showed antibacterial activities after 24 hours incubation. Malabaricon B showed antibacterial activity against Staphylococcus aureus, Bacillus subtilis, and Streptococcus durans with MIC value of 1 μg/mL for each species while malabaricon C with MIC value of 4 μg/mL, 2 μg/mL and 4 μg/mL, respectively compared to standard chloramphenicol (MIC value for S. aureus: 4 μg/mL, B. subtilis: 4 μg/mL, S. durans: 1 μg/mL). [35]
Macelignan from M. fragrans (10 μg/mL) reduced the extent of biofilms formed by oral primary colonizers such as Streptococcus mutans, Streptococcus sanguis and Actinomyces viscosus (grown in 24 hours) that attached to the pellicle-coated tooth surfaces in the process of early formation of tooth plaque by up to 30%, 38%, and 30%, respectively after 5 minutes treatment. However, the efficacy of macelignan as antibiofilm or anti-oral-bacteria depended on its concentration, exposure times and biofilm growth phases as evidenced by the treatment for duration 30 minutes which decreased the biofilm formation more than 50% for each bacterium. [36]
Antifungal
Malabaricon B and malabaricon C isolated from the M. fragrans mace have been found to have strong antifungal activities after 24 hours incubation. Malabaricon B showed antifungal activity against Candida albicans strains A, B and C with MIC value of 4, 8 and 16 μg/mL respectively whilst malabaricon C with MIC value of 8 μg/mL, 8 μg/mL and 32 μg/mL, respectively, compared to standard nystatin (MIC value for strain A: 2 μg/mL, strain B: 8 μg/mL, strain C: 16 μg/mL). [35]
Anti-inflammatory activity
Methanol extract of M. fragrans mace aril (0.3 and 1.0g/kg) administered orally to carrageenin-induced edema in rats and acetic acid-induced vascular permeability in mice showed anti-inflammatory activity compared with indomethacin. The fraction inhibited the edema and increased the vascular permeability (0.3 g/kg: 362.2±29.8 μg/animal, 1.0 g/kg: 172.1±18.5 g/kg animal), and reduced the number of writhings (0.3 g/kg: 29.3±3.9, 1.0 g/kg: 18.9±3.3), compared to 0.01 g/kg indomethacin (233.8±14.1 μg/animal, 22.3±4.0 number of writhings, respectively). [37]
Aphrodisiac activity
Ethanol:water (50% v/v) extract of M. fragrans dried seeds (500 mg/kg) administered orally to adult Swiss mice (23-35 g) and their mounting behaviour, mating activity and short term toxicity were observed and compared with 5 mg/kg standard drug Penegra (sildenafil citrate) and control. The result after 1 and 3 hours of treatment showed that the extract significantly stimulated the mounting behaviour (nutmeg: 5.00 ± 1.15 (p < 0.01), 6.16 ± 12.10 (p < 0.01); Penegra: 13.16 ± 3.02 (p < 0.001), 5.66 ± 2.05 (P < 0.01); control: (1.16 ± 0.68, 0.83 ± 1.06), respectively. The extract also increased the mating activity of the mice with the mean number of females (mean ± S.E.M.) mated by one male in control group was 1.33 ± 0.47 while for nutmeg was 3.66 ± 0.10 (p < 0.01), and 4.33 ± 0.94 (p < 0.001) for Penegra. [38]
Antihyperlipidaemic activity
Ethanol (50% v/v) extract of M. fragrans seed administered to hypercholesterolaemia-induced New Zealand White male rabbits (1.5-2.0 kg) showed reduction in serum cholesterol, LDL cholesterol and cholesterol/phospholipid ratio by 69.1%, 76.3% and 31.2% respectively. The extract elevated the HDL-ratio and prevented the accumulation of cholesterol, phospholipids and triglycerides in liver, heart and aorta and dissolved atheromatous plaques of aorta by 70.9-76.5%. Fecal excretion of cholesterol and phospholipids were increased in the treated rabbits. [39]
Osteoblast proliferation stimulation activity
Machilin A and other lignans isolated from methanol extract of M. fragrans dried seeds showed ability to stimulate osteoblastic differentiation in mouse MC3T3-E1 subclone 4 cells by activating p38 MAP kinase. Machilin A significantly (p < 0.0) increased ALP activity and showed more intense ALP staining compared with the differentiation medium (DM) control. Machilin A also significantly (p < 0.001) stimulated mineralization by measuring the deposited calcium level in a dose-dependent manner. [19]
Inhibition of melanogenesis activity
Methanol (80%) extract of M. fragrans seeds (333 μg/mL) inhibited the mushroom tyrosinase activity in order to elucidate their whitening effects. [40]
Macelignan isolated from ethanol extract of M. fragrans dried rhizomes inhibited the tyrosinase, tyrosinase-related protein-1 (TRP-1), and tyrosinase-related protein-2 (TRP-2) in melan-a murine melanocytes. The macelignan also decreased tyrosinase, TRP-1, and TRP-2 protein expression using Western blot analysis. [41]
Toxicity
Single doses (500 mg/kg) of ethanol (50% v/v) extract of M. fragrans dried seeds administered orally to adult Swiss mice (23-35 g) did not cause any mortality. There was found no gross behavioural changes at this dose, which corresponds to unani clinical dose and on which aphrodisiac activity of the drugs was observed. [38]
It was reported that myristicin induced CNS toxicity due to increased concentration of serotonin in the brain. Myristicin is a monoamine oxidase (MAO) inhibitor which could lead to an adverse reaction if taken with another MAO inhibitor. Myristicin was converted into an amphetamine derivative 3-methoxy-4, 5-methylene dioxyamphetamine which accounts for its euphoric effects. A liver fatty infiltration was reported as part of nutmeg oil toxicities. [42]
Reported cases of toxicity showed symptoms and signs appeared after 2-3 hours of ingestion of 1-3 whole nutmegs or 1-2 tablespoons of the powder. The hepatic P450 system seems to metabolize myristicin into 5-ally-1-methoxy-2, 3-dihydrobenzene which then undergoes glucuronidation and urinary excretion. [42]
Clinical Data
Clinical findings
No documentation.
Precautions
Pregnant women should not take nutmeg or be wary of the presence of nutmeg in food due to its abortifacient properties and its traditional use for the procurement of abortion. [43]
Side effects
Ingesting nutmeg oil (extracted from the dried ripe seed of M. fragrans) reported to cause adverse side effects such as nausea, vomiting, seizures and psychopharmacological effects. [44]
The intake of myristicin (a natural organic compound present in nutmeg oil) from essential oils and spices in food sometimes abused for its hallucinogenic properties. Ingestion of less than one tablespoon can produce symptoms similar to those of an anticholinergic toxic episode. [45]
Large doses of myristicin also may cause convulsions and narcotic effects. Overdosing of this herb can cause convulsions, vomiting and delirium. [46]
Pregnancy/Breast Feeding
Nutmeg intoxication has been reported during pregnancy (one tablespoonful of grated nutmeg) that caused acute anticholinergic hyperstimulation such as palpitations, agitation and blurred vision. The expectant mother whom showed slight pre-eclampsia symptoms was treated with morphine and activated charcoal. [46]
Age limitation
No documentation.
Adverse reaction
A 27 year old male subject was reported to have allergic reaction to mace powder (shell of nutmeg, M. fragrans). He had an immediate positive allergic reaction on skin prick test (SPT) against mace powder at a concentration of 10% (w/v). It was demonstrated that inhalation of mace powder resulted in an IgE-mediated reaction causing occupational asthma in this patient. [47]
Interaction & Depletion
Interaction with drug
No documentation.
Interaction with other Herbs
No documentation.
Contraindications
Nutmeg oil is considered to be toxic due to the myristicin content which affects the central nervous system (CNS). [46]
Myristicin content that related to the carcinogen safrole may cause hallucinations, visual impairments, delirium and prolonged sleep when used either orally or via inhalation. It can act as either a stimulant or a depressant of the CNS. Overdosing can cause convulsions (body shakes rapidly and uncontrollably), vomiting and delirium. [46]
Several intoxications were reported after ingestion of approximately 5 g of nutmeg, corresponding to 1–2 mg myristicin/kg body weight. Although these intoxications may be ascribed to the actions of myristicin, as the metabolism of myristicin resembles that of safrole, other components of nutmeg may also be involved. [44]
A 23 year old patient was brought to the Emergency Department of the General Hospital Dr. Manual Gea Gonzales, Mexico, in a state of general discomfort and dizziness. Ten hours prior to this he had consumed a whiskey, 2 beers and 50 g of nutmeg. Five hours later he complained of nausea and dizziness, the vomiting was induced. Eight hours later he complained of feeling of “impending doom”, palpitation and hallucination with visual impression of the wall of the room getting closer. Upon examination, there was slight midriasis with reactive pupils, orthostatic hypotension (Lying BP 120/55; standing 70/30). [45]
Poisonous Management
No documentation.
Line Drawing
References
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