Nicotine Poisoning: Causes, Symptoms and Treatment

Nicotine poisoning occurs when a person is exposed to harmful levels of nicotine, a toxic substance found in all tobacco products. Recently, there has been a rise in poisoning cases linked to liquid nicotine, which is often used in e-cigarettes and typically contains a higher concentration of nicotine than other tobacco products. Due to their smaller body size, children are particularly susceptible to nicotine toxicity.

Symptoms of nicotine poisoning can vary in severity but commonly include nausea and vomiting, an abnormally fast heart rate, dizziness, confusion, excessive drooling, and in more severe cases, seizures or respiratory distress. In children, even small amounts of nicotine—whether ingested, absorbed through the skin, or inhaled—can lead to serious health risks. 

What is Nicotine Poisoning?

Nicotine poisoning occurs when the body is exposed to excessive levels of nicotine, causing toxic effects. In the past, such poisoning was uncommon, usually resulting from the use of nicotine-based insecticides, accidental ingestion of tobacco, or consumption of nicotine-containing plants. However, with the rise of newer nicotine products like e-cigarettes and concentrated liquid nicotine, poisoning cases have become more frequent. These liquid forms often contain higher concentrations of nicotine than traditional tobacco products.

Nicotine is a naturally occurring toxic substance found in tobacco and is the primary cause of tobacco product addiction. It is present in cigarettes, cigars, e-cigarettes, chewing tobacco, snuff, pipe tobacco, nicotine replacement therapies (such as gum, patches, lozenges, inhalers, and nasal sprays), and in some older insecticides.

Routes of Nicotine Exposure

Nicotine poisoning can affect people of all ages, but children are at the highest risk due to their smaller size and lower body weight.

Nicotine can be absorbed through various routes:

• Skin absorption: This happens if nicotine in liquid form comes into contact with the skin, either through spills or direct contact.
• Inhalation: Nicotine can be absorbed into the lungs through smoke from traditional tobacco products or vapor from e-cigarettes.
• Ingestion: Nicotine can be absorbed through the mucous membranes in the mouth, such as from chewing tobacco or liquid nicotine, or through the intestines if e-cigarette refill liquids or pure nicotine are accidentally swallowed.

How does Nicotine Affect the Lungs?

Nicotine affects lung health in several ways:

1. Airway constriction: It tightens muscles around airways, making breathing harder, especially for those with asthma.
2. Increased mucus production: This leads to coughing and can contribute to chronic bronchitis.
3. Cilia impairment: Nicotine harms tiny lung structures that clear out mucus and particles, raising infection risk.
4. Reduced lung function: Long-term exposure can lead to conditions like COPD and emphysema.
5. Inflammation: It triggers lung inflammation, increasing susceptibility to infection.
6. Cancer risk: While not a carcinogen itself, nicotine can promote the growth of cancer cells when combined with other harmful substances in smoke.

Quitting smoking or vaping can help protect lung health

How Does Nicotine Addiction Start?

Nicotine addiction starts when someone first uses nicotine products like cigarettes or vapes. Here’s how it develops:

1. Initial use: Nicotine triggers dopamine release, creating pleasurable effects and reinforcing continued use.
2. Tolerance: Over time, more nicotine is needed to achieve the same effects, leading to increased use.
3. Dependence: The body becomes reliant on nicotine, and withdrawal symptoms like irritability and cravings occur without it.
4. Reinforcement: Nicotine use becomes a habit, often linked to specific situations or emotions.
5. Psychological addiction: People may use nicotine to cope with stress or boredom, deepening the addiction.

This combination of physical and psychological factors makes quitting difficult.

Symptoms of nicotine poisoning

Nicotine poisoning develops in two phases: the early phase and the late phase.

Early phase symptoms after nicotine ingestion include:

• Vomiting and nausea 
• Increased salivation
• Abdominal pain
• Pale skin
• Sweating
• High blood pressure
• Elevated heart rate
• Rapid, heavy breathing (hyperpnea)
• Loss of motor control (ataxia), difficulty walking, and trouble balancing
• Tremors
• Headache and dizziness
• Muscle twitching
• Seizures

Late phase symptoms may involve:

• Diarrhea
• Low blood pressure (hypotension) and slow heart rate (bradycardia)
• Abnormal heart rhythms
• Shock
• Coma
• Muscle weakness or paralysis
• Shallow or difficult breathing, leading to respiratory failure

Causes of nicotine poisoning

All tobacco products contain nicotine, which is harmful to health and can lead to poisoning if consumed in excessive amounts. Common sources of nicotine poisoning include:

• Smokeless tobacco, such as chew and snuff
• Liquid nicotine in e-cigarettes, which is more concentrated than in other tobacco products, and chewing or snorting tobacco, which delivers higher levels of nicotine into the body than smoking, are common sources of exposure.

Nicotine poisoning can also occur from:

• Using more nicotine replacement products than recommended, like excessive gum or lozenges
• Overdosing on nicotine patches, inhalers, or nasal sprays

While fatal nicotine poisoning is rare in adults due to their larger body size, combining multiple nicotine products increases the risk. Children are particularly vulnerable to nicotine overdose because of their smaller size. In children, poisoning is most often caused by:

• Ingesting cigarettes
• Absorbing liquid nicotine through the skin, swallowing it, or through mucous membranes in the mouth.

Diagnosis of nicotine poisoning

Increased levels of nicotine or its metabolite cotinine can be detected in:

• Urine
• Blood

Treatment of  nicotine poisoning 

Treatment for nicotine poisoning typically involves measures to reduce nicotine absorption, such as administering activated charcoal in a hospital setting. Care is also focused on managing specific symptoms, which may include:

• Benzodiazepines to control seizures
• IV fluids to stabilize blood pressure
• Atropine to raise heart rate if it drops too low
• Ventilator support to assist with breathing in cases of respiratory failure

Other treatments are provided as needed to address any additional symptoms or damage to the body.

Prevention of nicotine poisoning

To prevent nicotine poisoning, follow these safety measures:

• Keep all tobacco products, especially liquid nicotine, well out of reach and sight of children and pets.
• Always store nicotine products in their original containers.
• Seal used nicotine containers to prevent children or pets from accessing them, especially if they rummage through the trash.
• Consider quitting nicotine-containing products and consult your healthcare provider for support if needed.

Conclusion

Nicotine poisoning cases have been on the rise, primarily due to the growing use of newer nicotine products. Liquid nicotine is a frequent cause of poisoning, particularly in children, who may accidentally ingest or come into contact with it by touching, tasting, or swallowing liquid nicotine or e-cigarette products. To safeguard your family and pets from nicotine poisoning, the most effective strategy is to remove or prohibit tobacco and nicotine-containing products from your home.