Abstract
Background: Severe nicotine intoxication occurred in a patient after ingestion of
a tobacco extract made from a recipe found on a freely available Internet site. Objectives:
To determine the levels of nicotine and cotinine in the plasma of a patient who tried
to commit suicide by drinking a highly concentrated tobacco extract. Case report:
A 67-year-old man tried to commit suicide by following guidelines found on an Internet
site. He soaked 300 grams of tobacco for 3 days in water, evaporated most of the extract,
and drank the rest of it. He felt sick immediately, with the following signs: respiratory
depression, hypothermia, hypersalivation, bradycardia, and myoclonic jerks. Soon after
the ingestion he vomited most of the extract. Toxicological analysis revealed potentially
life-threatening nicotine and cotinine serum concentrations. Surprisingly, nicotine
peak levels (322 μg/L) and cotinine peak levels (9092 μg/L) were reached more than
3 h after ingestion of the extract. Estimated nicotine and cotinine half-lives were
200 min and 1185 min, respectively. Treatment consisted of gastric lavage, ventilation,
and monitoring of vital functions. The patient recovered and was discharged from the
Emergency Department 4 days later without sequelae. Conclusion: Nicotinergic intoxication
is not always easy to recognize, and without clues from the patient and the toxicologic
analysis, might well have been missed in the present case.
Keywords
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Article info
Publication history
Published online: March 09, 2009
Accepted:
October 22,
2008
Received in revised form:
September 17,
2008
Received:
June 24,
2008
Identification
Copyright
© 2010 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
