Nicotine Poisoning

Nicotine poisoning (toxicity) is the result of having too much nicotine in your body. Some people call it being “nic sick.”

Nicotine is a natural toxic substance found in tobacco products. It’s also the chemical that makes tobacco products addictive. It’s in:

• Cigarettes and e-cigarettes (vapes)
• Cigars and pipe tobacco
• Chewing tobacco and snuff (dip)
• Nicotine pouches
• Nicotine replacement products (like nicotine gum, patches, lozenges, inhalers and nasal spray)

Nicotine poisoning can affect anyone of any age. But the greatest risk is to children from accidental consumption. This is because of their lower body weight and smaller size. It can lead to serious complications — even death — without quick treatment.

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

Nicotine toxicity is a medical emergency. Get help as soon as possible. Call the U.S. Poison Center hotline at 800-222-1222 or call 911.

Symptoms of nicotine poisoning

Nicotine poisoning can occur in two stages: the early phase and the late phase. The early phase happens within 15 minutes to one hour of consuming too much nicotine. The late phase occurs within 30 minutes to four hours.

Early-phase symptoms after ingestion include:

• Nausea and vomiting (common)
• Skin paleness (common)
• Extra saliva (spit)
• Dizziness
• Abdominal pain
• Sweating
• Increased heart rate
• Rapid, heavy breathing
• Trouble with balance and walking
• Tremors and muscle twitching
• Headache

Late-phase symptoms include:

• Diarrhea
• Low blood pressure (which can cause dizziness and fainting)
• Slow heart rate (bradycardia)
• Abnormal heart rhythms
• Confusion and agitation
• Muscle weakness/paralysis

Get medical help right away if you or your child has any signs of nicotine poisoning.

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, they can last up to 18 to 24 hours.

Nicotine poisoning causes

All tobacco and nicotine products are harmful to your health. All of them can cause poisoning if you take them in large enough quantities.

But the leading causes of nicotine poisoning are smokeless tobacco products (chew and snuff) and liquid nicotine for e-cigarettes (vapes). The nicotine is more concentrated in liquid form. Chewing and snorting tobacco releases more nicotine into your body than smoking.

Children are much more prone to overdose because of their smaller body size. This mostly happens from eating cigarettes and consuming liquid nicotine. The liquid can get into their body by:

• Absorption through their skin
• Absorption through the mucous membrane in their mouth
• Swallowing it

Nicotine poisoning or overdose can also result from taking more than the recommended amount of nicotine replacement products. For example, you may chew too much gum or dissolve too many lozenges.

Complications of this condition

Mild nicotine poisoning typically doesn’t lead to complications. But severe poisoning can lead to:

• Seizures
• Shallow breathing and respiratory failure
• Coma
• Death

Death typically happens due to paralysis of the muscles that control your breathing. It can occur within one hour after severe exposure. Children are especially at risk.

Death from nicotine poisoning isn’t common in adults because of their larger body size. But using more than one type of nicotine-containing product at the same time may increase your risk.

How doctors diagnose this condition

Healthcare providers will ask about your symptoms and exposure to tobacco and nicotine. They’ll do a physical exam and check your vital signs. Because nicotine poisoning can worsen quickly, they may start treatment right away.

Your provider may test your pee to check the level of nicotine in your body. They may do other tests to check your overall health.

How is it treated?

You need treatment for nicotine poisoning in a hospital. Treatment may include:

• Activated charcoal to limit the absorption of nicotine in your intestines
• A ventilator to help deliver oxygen if you have respiratory failure
• Benzodiazepines to manage seizures
• IV fluids to treat low blood pressure
• Medications to stabilize your heart rate

Your healthcare team will monitor your vital signs closely. They’ll give you any other care you may need.

What can I expect if I have this condition?

Your outlook depends on:

• Your age and body size
• How much nicotine you took
• How quickly you get treatment

If you only develop mild (early-phase) symptoms, you’ll likely recover without any complications. Severe exposure and late-phase symptoms may lead to serious complications, like seizures and coma.

Long-term problems may happen if late symptoms lead to low oxygen to your brain.

Can this be prevented?

To help prevent nicotine poisoning, you can:

• Keep all tobacco products, especially products containing liquid nicotine, out of reach and out of sight of children and pets.
• Always store nicotine products in their original container.
• Seal used nicotine containers in case children or pets dig them out of the trash.
• Stop using 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.