Nicotine poisoning

Overview
Historically, most cases of nicotine poisoning have been the result of its use as an insecticide; however, such use is less frequent now than previously. Every year many children go to the emergency room after eating cigarettes or cigarette butts. Sixty milligrams of nicotine has the potential to kill an adult, which is the amount of nicotine in three packs of cigarettes or half a cigar, if all of the nicotine were absorbed. However, this figure is higher in regular smokers, although not drastically so. Consuming only one cigarette's worth of nicotine is enough to make a toddler severely ill. In some cases children have become poisoned by topical medicinal creams which contain nicotine.

Individuals who harvest or cultivate tobacco may experience Green Tobacco Sickness (GTS), a type of nicotine poisoning caused by dermal exposure to wet tobacco leaves.

Symptoms

 * Vomiting and nausea, diarrhea
 * Headaches
 * Difficulty breathing
 * Pallor
 * Sweating
 * Palpitations
 * Stomach pains/cramps
 * Seizures
 * Weakness
 * Drooling (or, for toddlers, more drooling than usual)
 * Skin lesions (caused by prolonged chain-smoking or excessive use of nicotine patches or chewing gum)

Physical process
These symptoms can be traced back to excessive stimulation of nicotinic cholinergic neurons. Initially, nicotine has a short-lived stimulatory-phase, followed by a longer inhibitory phase leading to neuromuscular blockade.

It is sometimes reported that people poisoned by organophosphate insecticides experience the same symptoms as nicotine poisoning, but this is not entirely true. Organophosphates inhibit an enzyme called acetylcholinesterase, causing a build up of acetylcholine, excessive stimulation of all types of cholinergic neurons, and a wide range of symptoms. Nicotine is specific for nicotinic cholinergic receptors only and has some, but not all, symptoms in common with organophosphate poisoning.

Diagnosing
Increased nicotine or cotinine (the nicotine metabolite) is detected in urine or blood, or increased serum nicotine levels occur.

Prognostic
It is said that if a patient survives nicotine poisoning during the first 4 hours, complete recovery is very likely.