What Is Nicotine Poisoning

  • Amber Iqbal BSc, Cancer Biomedicine, UCL, UK
  • Kajal MadhavaniMSc in Biomedical Science(Cancer Biology), University of Westminster

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Introduction

Nicotine poisoning, also known as nicotine toxicity or nicotine overdose, occurs when an individual is exposed to an excessive amount of nicotine, a highly addictive stimulant found in tobacco products. This exposure can result from various sources, such as smoking, vaping, or ingesting nicotine-containing products.

Nicotine poisoning can manifest with a range of symptoms, from mild to severe, affecting the nervous and cardiovascular systems. It is a potentially serious medical condition that requires prompt attention, and in severe cases, it may lead to life-threatening complications. The severity of nicotine poisoning depends on the amount of nicotine absorbed by the body and the individual's sensitivity to the substances.1,2,3

Nicotine basics

Nicotine is known to be extremely addictive and to have major systemic adverse effects. The heart, reproductive system, lungs, kidneys, and other organs are negatively impacted. Numerous studies have repeatedly shown that it has the potential to cause cancer.1,3 Since the 17th century, the only other known use of nicotine has been as an insecticide.

Its use decreased after World War II as more effective, less hazardous insecticides became more readily available. As of January 1, 2014, the United States Environmental Protection Agency has prohibited the use of nicotine as a pesticide. One of the biggest producers and exporters of nicotine sulfate, India has gradually outlawed the substance's usage as a pesticide in agriculture.1

The German physicians Karl Ludwig Reimann and Wilhelm Heinrich Posselt were the first to extract nicotine from tobacco. Nicotine is a strong alkaloid and is a transparent liquid with a distinct smell when it is pure. When exposed to air, it becomes brown. It separates from organic solvents more favourably and is soluble in water. It's an amine made up of rings of pyridine and pyrrolidine.

Since nicotine is a dibasic substance, the pH of the solution affects how readily and efficiently it is absorbed by the human body. The lungs, skin, stomach, or oral mucosa can all be used for absorption. Uncharged lipophilic nicotine, which can actively cross all biological membranes, is more concentrated in solutions with higher pH values.1

Nicotine is primarily found in tobacco plants, but it can also be synthesised or extracted for various purposes. Some of these sources are listed below:

Tobacco plants (Nicotiana tabacum and Nicotiana rustica)

The most common natural source of nicotine is the tobacco plant. Nicotiana tabacum is the species widely used in commercial tobacco products like cigarettes, cigars, and pipe tobacco. Nicotiana rustica, another species, contains higher nicotine levels and is used in some traditional and non-commercial tobacco products.4,5

Tobacco products

Nicotine is present in various tobacco-based products, including cigarettes, cigars, pipe tobacco, and smokeless tobacco (such as chewing tobacco and snuff).1,6

E-cigarettes and vaping products

Nicotine is a key component in e-liquids used in electronic cigarettes (e-cigarettes) and vaping devices. Vaping involves the inhalation of a vaporised nicotine solution.5

Nicotine Replacement Therapies (NRT)

NRT products are designed to help people quit smoking by providing controlled doses of nicotine. Common NRT products include nicotine patches, gum, lozenges, nasal sprays, and inhalers.1,6

Insecticides

Nicotine has historically been used as an insecticide due to its toxic properties. While its use in this context has declined, nicotine-based insecticides still exist.1

Synthetic production

Nicotine can be synthetically produced for various purposes, including pharmaceutical applications and research. Synthetic nicotine is chemically identical to the nicotine found in tobacco.7

Nicotine poisoning: causes and risk factors

There are several causes and risk factors for nicotine poisoning. Some of them include:

1.   Ingestion of nicotine-containing products

Accidentally swallowing products that contain nicotine, such as e-liquids for electronic cigarettes, nicotine gum, lozenges, or patches, can lead to nicotine poisoning.1,2

2.   Tobacco product consumption

Smoking or using smokeless tobacco products can result in nicotine poisoning if the consumption exceeds the body's ability to metabolise and eliminate nicotine.1,2

3.   Accidental ingestion by children

Children may accidentally ingest nicotine-containing products, including e-liquids or discarded cigarette butts, leading to nicotine poisoning due to their smaller body size and lower tolerance.1,2

4.   Skin exposure to concentrated nicotine

Direct contact with concentrated nicotine solutions, such as those used in the preparation of e-liquids for vaping, can lead to nicotine poisoning through absorption through the skin.1

5.   Inhalation of nicotine vapour

Inhaling vapour from e-cigarettes or other vaping devices can lead to nicotine poisoning if the concentration of nicotine is too high or if the individual inhales more than their body can tolerate.1,2

6.   Occupational exposure

Individuals who work in settings where nicotine is handled, such as in the production of tobacco products or nicotine-based insecticides, may be at risk of nicotine poisoning through skin contact or inhalation.1,8

7.   Misuse of Nicotine Replacement Therapies (NRT)

Using NRT products, such as nicotine patches, gum, lozenges, nasal sprays, or inhalers, inappropriately or in excessive amounts can lead to nicotine poisoning.1

8.   Storage and handling issues

Poorly stored nicotine-containing products or e-liquids, especially when accessible to children, can increase the risk of accidental ingestion and poisoning.

9.   Individual sensitivity and tolerance

Some individuals may be more sensitive to nicotine, and their tolerance levels can vary. Consuming nicotine beyond one's tolerance level can result in poisoning.1,2

Symptoms of nicotine poisoning

When individuals come into contact with nicotine directly, they experience burning and irritation in their mouths and throats, increased salivation, nausea, abdominal pain, vomiting, and diarrhoea. Although less common, gastrointestinal problems can nonetheless happen following skin and respiratory exposure.

Increases in blood pressure and pulse rate are the main immediate impacts, as observed in both human and animal investigations. Nicotine also causes an increase in plasma-free fatty acids, hyperglycaemia, and an increase in the level of catecholamines in the blood. Severe symptoms can lead to seizures and coma.1,2

Additionally, green tobacco sickness is an acute form of nicotine toxicity; the name arises from handling green tobacco leaves, with symptoms lasting from 12 to 24 hours. Headache, nausea, vomiting, giddiness, appetite loss, exhaustion, and tachyarrhythmias are among the acute symptoms. Green tobacco sickness (GTS) has not been associated with any large deaths, but it has a substantial negative impact on the health of those who work in the tobacco sector.1

Immediate actions for nicotine poisoning

In cases of nicotine poisoning, immediate support is required:

1.   Call for emergency medical assistance

Contact your local emergency services or poison control centre immediately for guidance and assistance.

2.   First aid measures

If the nicotine exposure occurred through ingestion, skin contact, or inhalation, follow any specific first aid instructions provided by medical professionals or poison control.

Prevention of nicotine poisoning

Preventing nicotine poisoning involves taking precautions to minimise the risk of exposure, especially in households where nicotine-containing products are present. Some key preventive measures include:

1.   Safe storage

Store all nicotine-containing products, including cigarettes, e-cigarettes, vaping liquids, and nicotine replacement therapies (NRT), in a secure location out of the reach of children and pets.

2.   Childproofing

Use childproof packaging for nicotine-containing products to reduce the likelihood of accidental ingestion by children. Child-resistant caps on e-liquid bottles can be particularly important.

3.   Educate and raise awareness

Inform household members, especially parents and caregivers, about the dangers of nicotine poisoning and the importance of keeping such products away from children and pets.

4.   Proper disposal

Dispose of used nicotine products, such as cigarette butts, e-cigarette cartridges, and nicotine patches, in a secure and inaccessible trash bin.

5.   Secure E-liquid containers

Keep e-liquid containers tightly closed and stored in a location where children or pets cannot easily access them.

6.   Use nicotine products responsibly

Follow the recommended dosage and usage instructions for nicotine replacement therapies and be cautious when using e-cigarettes or other vaping devices.

Treatment for nicotine poisoning

Treatment of nicotine poisoning varies between individuals in terms of severity, some of the treatments of choice are mentioned below:

1.   Activated charcoal

In cases of ingestion, activated charcoal may be administered to help absorb and reduce the absorption of nicotine in the digestive system.9

2.   Supportive care

Provide supportive care to manage symptoms, which may include:

  • Intravenous (IV) fluids to maintain hydration
  • Monitoring and support for respiratory function
  • Medications to control symptoms such as nausea, vomiting, and seizures10

3.   Monitoring

Continuous monitoring of vital signs (heart rate, blood pressure, respiratory rate) to assess the individual's condition and response to treatment.10

4.   Seizure management

In cases where seizures occur, medical professionals may administer anticonvulsant medications to control and manage seizures.10

5.   Respiratory support

In severe cases, individuals may require respiratory support, including intubation and mechanical ventilation, if respiratory failure occurs.10

6.   Gastric lavage (stomach pumping)

In some cases, particularly if ingestion occurred recently, healthcare professionals may perform gastric lavage to remove the ingested substance from the stomach.10

7.   Administration of atropine

In certain situations, atropine may be administered to counteract the effects of nicotine on the nervous system.11

8.   Continuous observation and follow-up

Individuals with nicotine poisoning may require continuous observation, and follow-up care is essential to monitor for any delayed or lingering effects.

Summary

Nicotine can be very addicting and damaging to our health. Its downsides can be as simple as nausea and headaches, all the way to heart, kidney, and immune system damage. It can also be a culprit in various types of cancers and deaths.

Detecting early signs of nicotine poisoning can help prevent mortality and complications. Alongside treatment, we need to try and avoid using nicotine by raising awareness in the community regarding its implications. We have only one life and the best way to appreciate it is by keeping ourselves safe and healthy.

References

  1. Mishra A, Chaturvedi P, Datta S, Sinukumar S, Joshi P, Garg A. Harmful effects of nicotine. Indian J Med Paediatr Oncol [Internet]. 2015 Jan [cited 2023 Dec 1];36(1):24–31. Available from: http://www.thieme-connect.de/DOI/DOI?10.4103/0971-5851.151771 
  2. Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol [Internet]. 2014 Jan 1 [cited 2023 Dec 1];88(1):5–7. Available from: https://doi.org/10.1007/s00204-013-1127-0 
  3. Brčić Karačonji I. Facts about nicotine toxicity. Arhiv za higijenu rada i toksikologiju [Internet]. 2005 Dec 7 [cited 2023 Dec 1];56(4):363–71. Available from: https://hrcak.srce.hr/125 
  4. Tariq M, Ahmad Z, Shah SA, Gul Z, Khan SA. Phytochemical analysis and antibacterial activity of nicotiana tabacum and nicotiana rustica. RADS Journal of Biological Research & Applied Sciences [Internet]. 2021 Jul 19 [cited 2023 Dec 1];12(1):60–5. Available from: https://www.jbas.juw.edu.pk/index.php/JBAS/article/view/317 
  5. Navas-Acien A. Global tobacco use: old and new products. Annals ATS [Internet]. 2018 Apr [cited 2023 Dec 1];15(Supplement_2):S69–75. Available from: https://www.atsjournals.org/doi/10.1513/AnnalsATS.201711-874MG 
  6. Digard H, Proctor C, Kulasekaran A, Malmqvist U, Richter A.  Determination of Nicotine Absorption from Multiple Tobacco Products and Nicotine Gum. Nicotine & Tobacco Research [Internet]. 2013 January [cited 2023 Dec 1]; 15(1): 255–261. Available from: https://academic.oup.com/ntr/article/15/1/255/1112360 
  7. ordt SE. Synthetic nicotine has arrived. Tobacco Control [Internet]. 2023 Apr 1 [cited 2023 Dec 1];32(e1):e113–7. Available from: https://tobaccocontrol.bmj.com/content/32/e1/e113 
  8. Faria NMX, Fassa AG, Meucci RD, Fiori NS, Miranda VI. Occupational exposure to pesticides, nicotine and minor psychiatric disorders among tobacco farmers in southern Brazil. NeuroToxicology [Internet]. 2014 Dec 1 [cited 2023 Dec 1];45:347–54. Available from: https://www.sciencedirect.com/science/article/pii/S0161813X14000837 
  9. Goel R, Bitzer ZT, Reilly SM, Bhangu G, Trushin N, Elias RJ, et al. Effect of charcoal in cigarette filters on free radicals in mainstream smoke. Chem Res Toxicol [Internet]. 2018 Aug 20 [cited 2023 Dec 1];31(8):745–51. Available from: https://pubs.acs.org/doi/10.1021/acs.chemrestox.8b00092 
  10. Seo AD, Kim DC, Yu HJ, Kang MJ. Accidental ingestion of E-cigarette liquid nicotine in a 15-month-old child: an infant mortality case of nicotine intoxication. Korean J Pediatr [Internet]. 2016 Dec [cited 2023 Dec 1];59(12):490–3. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5300914/ 
  11. Wigenstam E, Artursson E, Bucht A, Thors L. Supplemental treatment to atropine improves the efficacy to reverse nerve agent induced bronchoconstriction. Chemico-Biological Interactions [Internet]. 2022 Sep 1 [cited 2023 Dec 1];364:110061. Available from: https://www.sciencedirect.com/science/article/pii/S0009279722002666 

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Tatiana Abdul Khalek

PhD, Anglia Ruskin University, UK

I am a PhD student in Biomedical Science at Anglia Ruskin university and work as a quality control (QC) analyst (microbiology/chemistry) at EuroAPI. I have a MSc in Forensic Science from Anglia Ruskin (Cambridge) and I had experience in different roles such as quality lab technician at Fluidic Analytics, Research Assistant/Lab Manager at Cambridge University and Forensic Analyst at the The Research Centre in Topical Drug Delivery and Toxicology, University of Hertfordshire.

My PhD revolves around the use of nanoparticles and their role in cartilage degradation, as well as their potential as drug delivery vehicles for the treatment of diseases such as leukaemia.

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