Nicotine Poisoning

What is nicotine poisoning?

Nicotine poisoning refers to the toxic effects of consuming nicotine. Nicotine poisoning is the result of having too much nicotine in your body. Until recently, nicotine poisoning was rare. Most cases resulted from the use of nicotine as an insecticide, accidental ingestion of tobacco or ingestion of nicotine-containing plants.

Today, nicotine poisoning has become a growing concern because of new nicotine products on the market, particularly electronic cigarettes (e-cigarettes) and pure liquid nicotine. The concentration of nicotine in liquid products is higher than most other tobacco products.

Where is nicotine found?

Nicotine is a natural toxic substance found in tobacco products. It’s also the chemical that makes tobacco products addictive. Nicotine is found in cigarettes, cigars, e-cigarettes, chewing tobacco, snuff, pipe tobacco, tobacco plants, some insecticides (no longer in the U.S.), and in nicotine replacement products (nicotine gum, patches, lozenges, inhalers and nasal spray).

Who does nicotine poisoning mostly affect?

Nicotine poisoning can affect anyone of any age. However, the greatest risk of nicotine poisoning is in children because of their lower body weight and smaller size.

How is someone exposed to the effects of nicotine?

Nicotine can enter the body through:

• Absorption through your skin, if nicotine is in liquid form and spilled on the skin or touched.
• Inhalation into your lungs, from smoked products and electronic cigarettes.
• Ingestion and absorption through the mucous membrane of your mouth (from tobacco chew products or liquid nicotine) or through the intestines (after accidental swallowing of e-cigarette refill products or drinking liquid nicotine).

What is a lethal dose of nicotine?

According to the National Institute for Occupational Safety and Health, the lethal dose of inhaled nicotine is 50 to 60 mg/kg in a 70-kg adult (154 pounds).

Can a person overdose on nicotine from smoking alone?

It’s unlikely; however, it’s not impossible. There’s been one case report where two brothers smoked 17 and 18 pipes of tobacco in a row and were fatally poisoned.

Children may become ill after eating one cigarette. Eating more cigarettes may make a child severely ill.

Why are e-cigarettes dangerous?

Electronic cigarettes (e-cigarettes) are devices made to resemble cigarettes. They contain a battery, heater and liquid nicotine. When heated, the nicotine becomes a vapor, which users inhale.

With these products, it’s the liquid nicotine that can be dangerous, especially to children. According to the American Academy of Pediatrics, as little as one teaspoon of liquid nicotine can be fatal to a 26-pound child. Even liquid nicotine spilled on the skin can be poisonous within minutes.

Liquid refills are sold in quantities of 10 mL to more than 30 mL (about two to six teaspoons) in a variety of nicotine strengths. The products come in flavors with attractive scents and inviting packaging. If you purchase e-cigarettes and nicotine refill products, store them out of reach of your children and pets.

What are the signs and symptoms of nicotine poisoning?

Nicotine poisoning can occur in two stages: early phase and late phase.

Early phase symptoms after ingestion include:

• Nausea and vomiting. Vomiting occurs in more than 50% of people with symptoms.
• Increased salivation.
• Abdominal pain.
• Pale skin color.
• Sweating.
• Increased blood pressure.
• Increased heart rate.
• Rapid, heavy breathing (hyperpnea).
• Loss of full control of body movements (ataxia), loss of balance, difficulty walking.
• Tremors.
• Headache, dizziness.
• Muscle twitching.
• Seizures.

Late phase symptoms include:

• Diarrhea.
• Low blood pressure (hypotension) and slow heart rate (bradycardia).
• Abnormal heart rhythms.
• Shock.
• Coma.
• Muscle weakness/paralysis.
• Shallow breathing, difficulty breathing, respiratory failure.

How quickly does nicotine poisoning happen?

The early phase occurs within 15 minutes to one hour. Vomiting is the most common symptom of nicotine poisoning. The late phase occurs within 30 minutes to four hours.

How long do nicotine poisoning symptoms last?

Symptoms can last one to two hours if you’ve had mild exposure. If you’ve had severe exposure, symptoms can last up to 18 to 24 hours after exposure. Death can occur within one hour after severe exposure.

How does nicotine poisoning cause death?

Death typically happens due to paralysis of the muscles that control your breathing, fluid buildup in your airways and heart and blood vessel failure (cardiovascular collapse).

What causes nicotine poisoning?

All tobacco products contain nicotine and are harmful to your health. All are technically capable of causing poisoning if taken in large enough quantities. However, the leading causes of nicotine poisoning are smokeless tobacco products (chew and snuff) and liquid nicotine that’s used in e-cigarettes. The nicotine is more concentrated in liquid nicotine. Chewing and snorting tobacco releases more nicotine into the body than smoking.

Nicotine poisoning or overdose can also result from taking more than the recommended amount of nicotine replacement products (for example, chewing too much gum or dissolving lozenges) or taking too high of a dose of patches, inhalers or nasal sprays.

Death from nicotine poisoning is not common in adults because of their larger body size. However, using more than one type of nicotine-containing product at the same time can increase your risk.

Children are much more prone to nicotine overdose because of their smaller body size. Nicotine poisoning in children comes mostly from eating cigarettes and consuming liquid nicotine — either from absorbing spilled nicotine through their skin or through the mucous membrane in their mouth or from swallowing liquid nicotine.

How is nicotine overdose diagnosed?

Increased levels of nicotine or cotinine (nicotine metabolite) can be detected in urine or blood.

How is nicotine poisoning treated?

Treatment of nicotine poisoning may include activated charcoal to try to reduce absorption of nicotine in your intestines. This treatment is given in a hospital setting. Other treatments are given to treat specific symptoms. Treatments may include:

• Benzodiazepines to control seizures.
• Intravenous fluids (IV) fluids to treat low blood pressure.
• Atropine to treat slow heart rate.
• Ventilator to help deliver oxygen if there’s respiratory failure.
• Other treatments specific to other symptoms or bodily damage of the individual.

How can I prevent nicotine poisoning?

You can help prevent nicotine poisoning by:

• Keeping all tobacco products, especially products containing liquid nicotine, out of reach and out of sight of children and pets.
• Always storing nicotine products in their original container.
• Sealing used nicotine containers in case children or pets dig them out of the trash.
• Stopping the use of nicotine-containing products. Ask your healthcare provider for help.

If you or your child has been exposed to liquid nicotine, call the Poison Center hotline at 800-222-1222 or call 911.

What’s the outcome if a person experiences nicotine poisoning?

The prognosis depends on how much nicotine was taken and how quickly treatment was started. If a person is able to survive during the first four hours after poisoning, they’re usually likely to recover. If a person has been severely affected, they may have ongoing seizures or respiratory failure or other problems because of the damage done from low oxygen levels during the nicotine overdose event.

A note from Cleveland Clinic
Nicotine poisoning is on the rise, mostly due to the availability of some of the newer forms of nicotine that are now popular. Liquid nicotine is a common form of nicotine poisoning. Children eat cigarettes and can be accidentally poisoned by touching, tasting or swallowing liquid nicotine or liquid nicotine-containing products used in e-cigarettes. To keep you and your family and pets safe from nicotine poisoning, the most effective approach would be to eliminate or ban tobacco-containing or nicotine-containing products in your home. If you're interested in quitting smoking, your healthcare team is here, ready and looking forward to helping you.