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We present a case of acute nutmeg poisoning in a 16-year-old youth who had ingested the substance for recreational purposes. He developed a number of neurological symptoms and signs along with non-specific electrocardiographic changes and anti-cholinergic-type symptoms. We describe the pharmacology of nutmeg and its constituents, discuss its metabolism, and make recommendations about the management of nutmeg poisoning. Emergency staff should be aware of the effects of nutmeg, which may present in marijuana users who seek alternative substances.