Just in the Nic o’ tine

A 21-year-old man presented with palpitations, tremulousness, nausea, and vomiting. He reported ingesting one 14 mg nicotine patch in a suicide attempt. Initial vital signs include heart rate 132 bpm, blood pressure 140/80 mm Hg, temperature 37°C, respiratory rate 26 bpm, and pulse oximetry 100% on room air. Physical examination is remarkable for agitation, fine resting tremor, tachycardia, and pressured speech.   The lethal dose of nicotine is estimated to range from 1 mg/kg to 10 mg/kg. Reports of nicotine toxicity have occurred with the ingestion of as little as one whole cigarette or three cigarette butts in children under 6. E-cigarette consumption is on the rise, and cases of nicotine toxicity have been reported in children who have ingested the e-cigarette solution. The concentration of the nicotine refills is variable, containing 6 mg/ml (0.6%) to 100 mg/ml (10%). Assuming that 1 ml of solution is equal to 20 drops, one drop of the 10% solution would contain 5 mg of nicotine. Ingestion of as little as one drop of this concentrated solution would cause severe symptoms in children under 6.   Nicotine is well absorbed by various routes, the most rapid route being inhalation (5-60 seconds), followed by the buccal mucosa (15-30 minutes), GI tract (30-90 minutes), and dermal (4.2 hours). Nicotine has an elimination half-life of one to four hours, but the half-life may be shorter with habitual cigarette smoking and longer in dermal exposures.   The toxic effects of nicot...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs