21. Recreational food:if legal highs are in the kitchen 39th International Congress of the European Association of Poisons Centres and Clinical Toxicologists (EAPCCT) 21-24 May 2019, Naples, Italy

OBJECTIVE. Nutmeg is commonly used as a kitchen spice but for its psychotomimetic properties is also considered as legal high. Nitrous Oxide gained popularity among the youth and its misuse is alarming widespread. Hence, here are reported two cases of teenagers who gained easily these two legal highs for recreational and self-medication purpose. CASE SERIES.Case 1 The Poison Control Centre (PCC) of Policlinico Umberto I Hospital – Sapienza University of Rome, was alerted at 3:00 a.m. for a 16 years old boy, body weight 50 Kg, who ingested an amount of about 7 grams of nutmeg 14 hours before. He presented a clinical history of depressive mood and social isolation. After 6 hours from the ingestion he developed emesis, abdominal pain and headache. In particular, emesis was repeated and persistent. No psychotomimetic symptoms were reported. The PCC suggested the admission at the local Emergency Department (ED) to treat the emesis and to assess his suicidal risk. The boy revealed that he tried the nutmeg for its euphoria-inducing properties following some reports read on the Internet. Case 2 A 14 years old girl was admitted at the local ED as the result of inhaling nitrous oxide contained in a spray cream for recreational use. She reported nausea, dizziness, tachycardia (heart rate: 106 bpm) and anterograde amnesia. The PCC was alerted and suggested to monitor vital signs and to perform an Arterial Blood Gas (ABG) test to check the risk of methemoglobinemia. No abnormalities were detected and the patient was discharged without symptoms 6 hours later. She revealed to inhale the nitrous oxide with friends after reading the procedure on the Internet. CONCLUSIONS. Although these two cases have low clinical relevance because of the transient and minor symptoms presented, they allow some considerations: i) the lasting trend among the youth to search information on the Internet about substances usually sold and easily available, ii) the use of these substances even as self-medication, iii) the easy availability may underestimate the risks associated to their abuse mostly among the youth, iv) the variability in the psychopharmacological response as well as the concentrations of its active components not ensure a “safe” level of exposure in the context of nutmeg intoxication .