title: Myristicin and phenytoin toxicity in an infant.
abstract: 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.
authors.affiliation: Department of Pediatrics, ESI-PGIMSR, Chennai, Tamilnadu, India.
authors.forename: Shobhana
authors.initials: S
authors.lastname: Sivathanu
authors.affiliation: Department of Pediatrics, ESI-PGIMSR, Chennai, Tamilnadu, India.
authors.forename: Sowmya
authors.initials: S
authors.lastname: Sampath
authors.affiliation: Department of Pediatrics, ESI-PGIMSR, Chennai, Tamilnadu, India.
authors.forename: Henry Suresh
authors.initials: HS
authors.lastname: David
authors.affiliation: Department of Pediatrics, ESI-PGIMSR, Chennai, Tamilnadu, India.
authors.forename: Kulandai Kasthuri
authors.initials: KK
authors.lastname: Rajavelu
mesh_terms: D000081248:Allylbenzene Derivatives; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001593:Benzyl Compounds / Q000506:poisoning*; D004148:Dioxolanes / Q000506:poisoning*; D006801:Humans; D007223:Infant; D008297:Male; D026323:Myristica / Q000506:poisoning*; D010672:Phenytoin / Q000009:adverse effects* / Q000627:therapeutic use; D011748:Pyrogallol / Q000031:analogs & derivatives* / Q000506:poisoning; D012640:Seizures / Q000139:chemically induced; D013226:Status Epilepticus / Q000139:chemically induced*
chemical_list: D000081248:Allylbenzene Derivatives; D000927:Anticonvulsants; D001593:Benzyl Compounds; D004148:Dioxolanes; D011748:Pyrogallol; C005246:myristicin; D010672:Phenytoin