Myristicin and phenytoin toxicity in an infant.

Shobhana Sivathanu, Sowmya Sampath, Henry Suresh David, Kulandai Kasthuri Rajavelu

BMJ case reports 2014 Jun 05

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A developmentally normal infant presented with repeated episodes of afebrile status epilepticus following nutmeg ingestion. He had developed two episodes of afebrile status epilepticus and had received different treatments earlier, but the details of treatment were not available. On admission, he redeveloped convulsions and loading doses of phenytoin, phenobarbitone and midazolam were administered. However, seizures persisted and extrapyramidal movements, nystagmus and visual dysfunction were noted. Iatrogenic phenytoin toxicity was considered and confirmed by drug levels. His symptoms completely disappeared after discontinuation of phenytoin therapy. The initial seizures were attributed to myristicin, an active component of nutmeg, because of the temporal association. However, the subsequent seizures were due to phenytoin toxicity caused by administration of multiple loading doses. This case highlights that nutmeg, a spice, can cause serious toxic effects like status epilepticus. Furthermore, treatment of status epilepticus with phenytoin can cause iatrogenic seizures due to its narrow therapeutic range. 2014 BMJ Publishing Group Ltd.

Citation

Shobhana Sivathanu, Sowmya Sampath, Henry Suresh David, Kulandai Kasthuri Rajavelu. Myristicin and phenytoin toxicity in an infant. BMJ case reports. 2014 Jun 05;2014