Nicotine poisoning

Nicotine poisoning
Classification and external resources
Nicotine
ICD-10	F17.0, T65.2
DiseasesDB	30389

Nicotine poisoning describes the symptoms of the toxic effects of consuming nicotine, which can potentially be deadly. Historically, most cases of nicotine poisoning have been the result of use of nicotine as an insecticide.

Sixty milligrams of nicotine (the amount in about 30-40 cigarettes ^[1]), has the potential to kill an adult who is not a smoker^[2] if all of the nicotine were absorbed. This figure is ~120 mg in chronic cigarette smokers, smoking an average of 20 non-light cigarettes delivering ~1.7 mg of nicotine each daily. One cigarette's-worth of nicotine is enough to make a toddler severely ill. In some cases children have become poisoned by topical medicinal creams which contain nicotine.

People who harvest or cultivate tobacco may experience Green Tobacco Sickness (GTS), a type of nicotine poisoning caused by dermal exposure to wet tobacco leaves.^[3]

Symptoms

• Vomiting and nausea, diarrhea
• Headaches
• Difficulty breathing
• Pallor
• Sweating
• Palpitations
• Lisps
• Stomach pains/cramps
• Seizures
• Weakness
• Drooling

Physical process

These symptoms can be traced back to excessive stimulation of nicotinic cholinergic neurons. Initially, nicotine has a short-lived stimulatory-phase, followed by a longer inhibitory phase leading to neuromuscular blockade.

It is sometimes reported that people poisoned by organophosphate insecticides experience the same symptoms as nicotine poisoning. Organophosphates inhibit an enzyme called acetylcholinesterase, causing a build up of acetylcholine, excessive stimulation of all types of cholinergic neurons, and a wide range of symptoms. Nicotine is specific for nicotinic cholinergic receptors only and has some, but not all of the symptoms of organophosphate poisoning.

Diagnosing

Increased nicotine or cotinine (the nicotine metabolite) is detected in urine or blood, or serum nicotine levels increase.

Toxicology

The LD₅₀ of nicotine is 50 mg/kg for rats and 3 mg/kg for mice. 0.5-1.0 mg/kg can be a lethal dosage for adult humans, and 10 mg for children^[2][4]. Nicotine therefore has a high toxicity in comparison to many other alkaloids such as cocaine, which in mice has an LD₅₀ of 95.1 mg/kg. A person can overdose on nicotine through a combination of nicotine patches, nicotine gum, and/or tobacco smoking at the same time. ^[5][6] Spilling an extremely high concentration of nicotine onto the skin can result in intoxication or even death since nicotine readily passes into the bloodstream from dermal contact.^[7]

Prognosis

The prognosis is typically good when medical care is provided. It has been stated that if a patient survives nicotine poisoning during the first 4 hours, they usually recover completely.^[8]

References

1. ^ Washington Post - 2006
2. ^ ^{a b} IPCS INCHEM
3. ^ Schep LJ, Slaughter RJ, Beasley DM (September-October 2009). "Nicotinic plant poisoning". Clinical Toxicology (Philadelphia, Pa.) 47 (8): 771–81. doi:10.1080/15563650903252186. PMID 19778187. 
4. ^ Okamoto M, Kita T, Okuda H, Tanaka T, Nakashima T (Jul 1994). "Effects of aging on acute toxicity of nicotine in rats". Pharmacol Toxicol. 75 (1): 1–6. doi:10.1111/j.1600-0773.1994.tb00316.x. PMID 7971729. 
5. ^ http://learn.genetics.utah.edu/content/addiction/drugs/overdose.html
6. ^ http://www.drugtext.org/library/articles/coffin.htm
7. ^ Lockhart LP (1933). "Nicotine poisoning". Br Med J 1 (3762): 246–7. doi:10.1136/bmj.1.3762.246-c. 
8. ^ Saxena K, Scheman A (December 1985). "Suicide plan by nicotine poisoning: a review of nicotine toxicity". Vet Hum Toxicol 27 (6): 495–7. PMID 4082460. 

External links

• How Stuff Works:Nicotine
• [1]
• Nicotine Poisoning In Pets
• Child Poisoned By Topical Medicinal Cream