Mace Poisoning: Accidental Toxic Ingestion in a Child Leading to a Reversible Coma

Nutmeg and mace are commonly known for their medicinal and culinary properties. The chemical compounds found in nutmeg and mace, notably myristicin, elemicin, and safrole, have been implicated in the psychoactive and anticholinergic effects that are the result of acute toxicity. Cases of mace toxicity are not as commonly reported as nutmeg toxicity. We report a six-year-old child, who presented with serotonergic and anticholinergic symptoms, with an altered level of consciousness and respiratory acidosis after unintentionally ingesting six pieces of mace. She recovered with supportive care alone and was discharged 36 hours post-ingestion. Myristicin acts by moderately inhibiting monoamine oxidase, causing anticholinergic symptoms. It also leads to the formation of the metabolite 3-methoxy-4,5-methylendioxy amphetamine (MMDA), responsible for its psychedelic effects. Both intentional and unintentional toxicity by nutmeg have been reported widely, the latter occurring more commonly in children less than 13 years of age. This case highlights the potential toxicity of mace ingestion and demonstrates the need for heightened awareness among families to prevent accidental exposures.