Nicotine poisoning is a pathological condition caused by an overdose of nicotine and its derivatives. The condition occurs when smoking a large number of cigarettes in a short time, accidentally ingesting tobacco products, using electronic cigarettes. Intoxication is manifested by respiratory disorders, gastrointestinal disorders, a consistent change of psychomotor agitation and depression of consciousness. Specific tests for nicotine in biological fluids and intensive care monitoring are required to diagnose poisoning. Treatment includes respiratory support, the use of enterosorbents and cardiotropic agents.
In the USA, more than 36 million men and 8 million women smoke, about 50-70% of teenagers under 18 have tried cigarettes at least once. Against this background, the number of accidental nicotine poisoning is increasing, and about 50% of cases are registered in children under 6 years of age with accidental ingestion or chewing of tobacco products. Nicotine-containing compounds belong to strong neurotropic poisons, therefore intoxication poses a threat to the life and health of patients and requires urgent medical care.
Nicotine poisoning when smoking ordinary cigarettes is rare, since only part of the toxic substance enters the body. In addition, smokers with experience adapt to the pharmacological effects of nicotine-containing compounds, so even high concentrations do not cause acute symptoms. Most often intoxication develops in the following cases:
- Smoking electronic cigarettes. The liquid for filling the devices contains nicotine sulfate, a strong toxin that was previously used as an insecticide. In the 18-24 age group, more than 10% of americans are vaping consumers, so the risk of poisoning is constantly growing.
- Ingestion of tobacco products. A large number of cigarette butts on the streets, the presence of cigarettes or vaping liquids at home poses a threat to young children who may accidentally swallow a dangerous substance. In such a situation, intoxication develops rapidly and proceeds heavily.
- Professional factors. Occasionally, nicotine poisoning is observed among workers who collect tobacco leaves on plantations. This pathology is called “green tobacco disease”.
The risk of poisoning increases if a person combines nicotine-containing products with other psychotropic substances. With the joint use of alcohol and smoking, severe intoxication is possible due to loss of control, increased absorption of cigarette resins into the body, disruption of the work of higher nerve centers. Risk factors include a combination of cigarettes and energy drinks, strong coffee. There is a high probability of poisoning in people who eat poorly and are used to smoking a few cigarettes on an empty stomach.
The average lethal dose of nicotine for an adult is 30-60 mg when the solution gets on the skin or mucous membranes. However, new data show that the dangerous threshold of the substance can be several times higher – 200-500 mg. Children are more sensitive to the action of the toxin, death can occur even if 10 mg of nicotine enters the body. For comparison, a regular cigarette contains 9-30 mg of nicotine-containing compounds, of which 0.5-2 mg penetrates into the blood when smoking.
When inhaling cigarette smoke, nicotine quickly enters the bloodstream due to the large area of absorption, reaches the brain in 10-20 seconds. after the first puff. The substance can accumulate in saliva and gastric juice, liver, kidneys. The rate of nicotine metabolism depends on the genetic polymorphism of cytochrome P450, so the same dosages have different effects on different people.
Large doses of nicotine easily penetrate the hemato-encephalic barrier and block nicotine-sensitive cholinergic receptors. The substance causes inhibition processes in the central nervous system, depresses the respiratory center, causes epileptiform activity of the brain. Nicotine-containing components are characterized by a specific two-phase effect on the nervous and cardiovascular system, which determines the features of the clinical picture.
With acute intoxication, there is increased salivation, nausea and vomiting, stool disorders. Severe headache are characteristic. First, nicotine increases blood pressure and slows down the heartbeat, as the poisoning progresses, the opposite effects develop. The patient suffers from shortness of breath, which is gradually replaced by rare irregular breathing.
Brain damage is manifested by anxiety, psychomotor agitation, tonic-clonic seizures. Visual and hearing impairments occur, hallucinations, senestopathies are possible. At the beginning of intoxication, the pupils dilate, in a serious condition of the patient, they narrow. Occasionally, delirious syndrome develops. Severe nicotine poisoning is characterized by loss of consciousness, suppression of all vital functions.
Chronic nicotine intoxication is characterized by a variety of clinical picture. The defeat of the nervous system is manifested by neurasthenia, sleep disorders, decreased memory and concentration. From the cardiovascular system, arrhythmias, angina attacks occur. Chronic inflammatory processes of the respiratory tract, decreased taste and sense of smell are characteristic.
Nicotine poisoning is a deadly condition. Without emergency medical care, patients die from respiratory center paralysis. Fatal cases are more often observed among young children when nicotine-containing products are ingested through the gastrointestinal tract. In the period of intoxication, vascular spasm is observed, which increases the risk of myocardial infarction, stroke.
Chronic nicotine intoxication can cause COPD, laryngeal and lung cancer. Patients are more likely to have atherosclerosis and diabetes mellitus, atrial and ventricular fibrillation occur much more often. The lesion of the vessels of the legs is manifested by obliterating endarteritis and thrombophlebitis, the toxic effect on the gastrointestinal tract manifests itself in the form of ulcers and stomach cancer.
In acute nicotine poisoning, a shortened examination of the patient by an anesthesiologist-resuscitator is carried out, since it is necessary to start relieving dangerous symptoms as soon as possible. Often, the final diagnosis is made after the stabilization of the patient and the restoration of vital functions. To confirm nicotine intoxication and assess its severity,:
- Electrocardiography. The technique is necessary to assess the heart rate, identify bradycardia and life-threatening arrhythmias that require urgent correction. To simplify the procedure, an automatic 12-channel ECG recording is performed in the intensive care unit using an automatic monitor.
- Nicotine level analysis. As a screening, test strips are used to examine urine, which give a result after a few minutes. Determination of the exact concentration of nicotine and its metabolite cotinine is carried out by highly specific blood and saliva tests.
- Examination of blood gases. Acute respiratory disorders cause severe hypoxia and hypercapnia, which are determined during the treatment of the patient in the intensive care unit. Additionally, the pH of the blood is evaluated, which correlates with its gas composition.
- Standard laboratory complex. To assess the general condition and severity of organ disorders, a hemogram, a biochemical blood test with liver samples, and an assessment of creatinine clearance are prescribed. A general urinalysis and a hemostasiogram are also performed.
With mild variants of intoxication, it is necessary to provide the victim with access to fresh air, remove tight clothes. If thirst arises, you need to drink clean water without gas, any other drinks are prohibited. Patients who accidentally swallowed nicotine-containing substances should be rinsed out: give a large amount of water to drink and cause vomiting. Washing is not carried out for young children, people with impaired consciousness.
The greatest danger is the oppression of the respiratory center in the medulla oblongata, therefore, patients in an unconscious state need ventilation by the “mouth to mouth” or “mouth to nose” method. First aid can be provided by people who have undergone appropriate training (trainings, courses), as well as passers-by or relatives, if they are generally familiar with the rules of performing artificial respiration.
The poisoning treatment plan includes supportive and symptomatic methods that are selected taking into account the severity of the condition. In case of respiratory disorders, artificial ventilation and oxygen therapy are indicated, anticonvulsants and anxiolytics are used to correct seizures. Cardiotropic and cardiometabolic drugs are also prescribed.
In non-severe forms of poisoning, gastric lavage is used in toxicology if several hours have passed since the ingestion of nicotine. Enterosorbents are used to bind and quickly remove toxins from the gastrointestinal tract. Mild variants of intoxication in adults do not require hospitalization, since with modern medical care, the patient’s condition normalizes within 24 hours.
Prognosis and prevention
Most cases of nicotine poisoning in adults occur in a mild or moderate form, after the removal of toxins from the body, well-being is normalized. The prognosis depends on the dose taken, the age and the somatic status of the patient. To prevent intoxication, explanatory work on the dangers of electronic cigarettes, promotion of smoking cessation, a strict ban on the use of nicotine-containing products by minors is necessary.