In the United States, the American Association of Poison Control Centers at 800-222-1222 is available 24 hours a day to connect callers directly to their region's poison center. They are also available online.
- Assess and address airway, breathing, and circulation (ABCs).
- If exposure is cutaneous, remove clothing near the affected area and cleanse the skin with water and soap.
- Severely poisoned patients may need fluid resuscitation, vasopressors, and treatment for seizures, dysrhythmia, and acidosis.
- Vital sign abnormalities such as tachycardia or fever should be treated supportively.
With the popularity of electronic cigarettes (e-cigarettes), liquid nicotine use has increased greatly over the past decade. High-potency liquid nicotine products are often sold in flavors that are attractive to children and are not stored safely away from children, allowing them to be exposed through ingestion, skin absorption, or inhalation. Most calls to US poison control centers involving liquid nicotine poisoning are for children aged 5 years and younger, but anyone of any age can be affected. It takes approximately 1.4 mg/kg of body weight for nicotine to have toxic effects. While acute nicotine poisoning is relatively rare in adults, pediatric overdose is an increasing trend.
Nicotine affects several systems in the body. Primarily, it leads to sympathetic nervous stimulation from binding to nicotinic cholinergic receptors. Nicotine can also penetrate the blood-brain barrier, leading to seizures, coma, and emesis.
Typical symptoms of mild exposure in children include vomiting, dizziness / vertigo, abdominal pain, ocular irritation / pain, tachycardia, and headache. Mild nicotine exposure often results in gastrointestinal symptoms only. Symptoms increase in severity with greater nicotine exposure, leading to tremors and fasciculation, ataxia, confusion, agitation, decreased level of consciousness, coma, seizures, and potentially (rarely) death. Other symptoms include conjunctivitis, diaphoresis, tachypnea, hypertension, and bronchoconstriction.
