Nicotine poisoning: symptoms and treatment

© Image: Snuzone

In moderation, nicotine can have a pleasantly stimulating effect on the body. However, if there is too much of a good thing, negative and undesirable effects can quickly occur. In extreme cases, this can lead to nicotine poisoning. In this article, you can read about the most common causes of such intoxication and the symptoms that can occur. You will also find out what measures should be taken in an emergency.

How nicotine poisoning develops

Nicotine poisoning can have a variety of causes, although in all cases the amount of nicotine ingested by the body is too high. The most common reasons for a nicotine overdose include:

• Excessive consumption of tobacco/nicotine products: Usually too large quantities of strong smoking tobacco, snuff or chewing tobacco are consumed in a short period of time.
• Ingestion of tobacco and nicotine products: Nicotine and especially tobacco products such as chewing tobacco and Snus are accidentally swallowed during consumption. In addition, if not kept out of the reach of children, they may swallow nicotine-containing e-cigarette liquids.
• Improper use of nicotine replacement therapy products: Nicotine patches, nicotine gum or nicotine lozenges can lead to a nicotine overdose if the dosage is too high or if they are used incorrectly.
• Skin contact with nicotine solutions: Nicotine can also be absorbed by the body through the skin. In particular, contact with high-dose nicotine-containing liquids poses an increased risk. If some of it also gets into the eye, particular caution is required.

Most reported cases of nicotine poisoning are considered mild forms and are largely due to the ingestion of tobacco products. Nevertheless, severe symptoms of poisoning are possible if children in particular swallow nicotine and tobacco products, as they are much more susceptible to a nicotine overdose due to their low body weight. E-cigarette liquids can also pose a particular danger here if their packaging is brightly colored and has fruit printed on it, thereby arousing the interest of (young) children who are keen to experiment.

If a (small) child eventually swallows large quantities of the nicotine-containing liquids, it can be dangerous - in the worst case even with fatal consequences. And although most e-liquid packaging has a child safety lock, the possibility of such a danger cannot be completely ruled out.

It is therefore essential to protect children as much as possible from swallowing nicotine-containing substances by keeping tobacco and nicotine products out of their reach.

How many cigarettes lead to nicotine poisoning?

The saying "the dose makes the poison" probably gets to the heart of the matter here. However, the amount of nicotine that actually has a toxic effect on a person is linked to a number of factors such as age, gender, weight, and so on. It is also important to bear in mind the habituation effect, which considerably increases nicotine tolerance in heavy smokers, for example. What may simply represent a "higher dose" for them could lead to (mild) symptoms of intoxication in the case of non-smokers.

It is therefore not possible to make a blanket statement about how many cigarettes lead to nicotine poisoning. Nevertheless, the following consideration could put the possible risk of poisoning, and above all a lethal dose of nicotine, from smoking tobacco cigarettes into perspective:

• A conventional tobacco cigarette has a nicotine content of up to 13 mg, of which around one to two milligrams are absorbed by the body when smoked.
• It is now assumed that around 500 milligrams of nicotine is a lethal (fatal) dose for an average adult male.

Accordingly, only 250 to 500 cigarettes would be lethal. In addition, the risk of poisoning from the 1-2 mg of nicotine ingested when smoking seems less likely than when swallowing nicotine/tobacco products, when the latter results in a significantly higher nicotine intake.

How many Snus lead to nicotine poisoning?

What has just been mentioned also applies here - a blanket statement on how many Snus lead to nicotine poisoning is therefore not possible.

Nevertheless, the following can also be put into perspective here: When consuming Snus and nicotine pouches, i.e. placing them under the upper lip, according to a Swedish study, slightly more of the nicotine contained in the pouches seems to be absorbed by the body*1 - however, nicotine poisoning still seems unlikely due to the mg quantities dissolved purely from the pouches.

For example, a health assessment by the Federal Institute for Risk Assessment, which is based on this study, states that only 2.41 mg could have been "extracted" from a Swedish snus pouch with 8 mg during consumption, and 3.79 mg from a nicotine pouch with 8 mg.*2 However, "extracted" should not be readily equated with "absorbed by the body", because this would imply that whatever nicotine is released from the pouch must also be absorbed by the body in its entirety. But even if this were the case, the Swedish Snus with 8 mg would require 208 pouches and the nicotine pouch with 8 mg 132 pouches to reach the lethal dose mentioned.

*1 Cf: Lunell, E., et al, Pharmacokinetic Comparison of a Novel Non-tobacco-Based Nicotine Pouch (ZYN) With Conventional, Tobacco-Based Swedish Snus and American Moist Snuff. Nicotine Tob Res, 2020. 22(10): p. 1757-1763.

*2 Cf: https://mobil.bfr.bund.de/cm/343/gesundheitliche-bewertung-von-nikotinbeuteln-nikotinpouches.pdf , page 10

Nicotine poisoning symptoms

The symptoms of nicotine intoxication can be varied and usually occur in two stages, particularly in the case of severe intoxication. The following symptoms may occur within a few minutes of ingesting too much nicotine:

• General malaise and nausea, resulting in vomiting
• Seizure-like abdominal/stomach pain with possible cramps
• Excessive saliva production
• Skin pallor and cold sweats
• Dizziness and circulatory problems
• headaches
• Rapid, heavy breathing
• Increased heartbeat and palpitations (especially perceived strong heartbeat)
• Trembling
• Increased blood pressure

After about 30 minutes to four hours, the initial symptoms may change to:

• Diarrhea
• Slow heartbeat
• Difficulty breathing, respiratory depression
• Drop in blood pressure
• Lethargy, confusion, clouding of consciousness or even unconsciousness
• seizures
• In extreme cases, a state of shock and cardiovascular arrest can be the result

Difference between nicotine overdose and nicotine intoxication

Depending on the severity and duration of the symptoms, a distinction can be made between a mild overdose and severe nicotine intoxication. In the former, the symptoms tend to be mild and usually subside after one to two hours - in the latter, however, they are much more severe and can even last up to 24 hours.

What you can/should do in the event of nicotine poisoning

If symptoms occur, it is always important to remain calm/reassure the person concerned, monitor them and contact the emergency services immediately. In addition to country-specific emergency numbers, the Euro emergency number "112" can be used free of charge in all EU countries.

Depending on the severity of the symptoms of poisoning, we also recommend important first aid measures that can and should be taken immediately:

• For example, in the event of nausea, stomach pain, dizziness, circulatory problems or even clouding or loss of consciousness, the affected person should be placed in the recovery position and care should be taken to ensure that the airways are clear. It also helps to open any constricting clothing and cover the person up warmly.
• If the person loses consciousness, special care must be taken to ensure that the airways remain clear - if the person is no longer breathing and cardiac arrest occurs, start chest compressions and mouth-to-mouth resuscitation immediately.

If there is a suspicion that tobacco products may have been ingested, for example, but the person concerned does not (yet) show any symptoms, they should be monitored in any case. In addition, the respective country-specific poisoning information center/poison control center should be contacted.

>> For Germany, Austria and Switzerland can be found here: a list of telephone numbers

In the case of children, you should also always check the mouth for any residue of the nicotine-containing substance and remove it if necessary.

What you should not do in the event of nicotine poisoning

The list of things you should not do is long. It is best to follow the instructions of the emergency services or the poison control center and ask if necessary if you are unsure. The following measures should not be taken as they could do more harm than good:

• Never force vomiting by taking various measures!
• If you already have nausea and abdominal pain, you should not force yourself to drink fluids.
• Especially with (small) children: Do not give them milk to drink!
• In case of nausea, dizziness and circulatory problems, the poisoning victim should not be laid on their back, but rather placed in the recovery position.

What is the best way to deal with a nicotine overdose?

Good news first: nicotine is a substance that breaks down relatively quickly in the body. On average, an improvement can be seen after one to two hours.

If the symptoms are mild and there is no worsening after around 30 minutes, it is likely that there is a "mere" overdose. In this case, you should also remain calm and monitor the progress closely. In this case, fresh air and a sufficient supply of fluids can help to speed up the breakdown of nicotine.

A tip for consumption: If you consume carefully, you don't run the risk of a nicotine overdose due to excessive consumption of tobacco/nicotine products. Know your limits and consume responsibly!

>> You might be interested at this point: Quit smoking with Nicotine Polacrilex and White Snus