Ingesting large quantities of nutmeg can cause psychoactive and hallucinogenic effects. A 23-year-old man on long-term fluoxetine and quetiapine who ingested 75 g of nutmeg with suicidal intent developed tachycardia and mydriasis four hours later, became somnolent after about 14 hours, and all symptoms resolved spontaneously within 26 hours. Analysis of enquiries to the Swiss national poison information center from 2014 to 2023 identified 236 patients (51% female, ages 0–85). The highest number of enquiries (30) occurred in 2020 and 2021, coinciding with a TikTok nutmeg challenge and increased home baking during the COVID-19 pandemic. Nutmeg intoxications usually show a mild course, and incidence may be subject to social influences.
Methoxphenidine, a novel dissociative designer drug of the diarylethylamine class with structural features similar to phencyclidine (PCP), produced PCP-like adverse effects in a 53-year-old man found on the street in a somnolent and confusional state. Observed signs included tachycardia (112 bpm), hypertension (220/125 mmHg), echolalia, confusion, agitation, opisthotonus, nystagmus, and amnesia. Temperature and oxygen saturation were normal. Laboratory findings showed elevated creatine kinase (max 865 U/L), alanine aminotransferase (72 U/L), and gamma-glutamyl transpeptidase (123 U/L). Methoxphenidine was confirmed in plasma and urine via liquid chromatography tandem mass spectrometry. The patient recovered with symptomatic treatment.