Citation

Schneider S, Diederich N, Appenzeller B, Schartz A, Lorang C, Wennig R. J. Emerg. Med. 2010; 38(5): 610-613.

Affiliation

Laboratoire National de Sante, Division de Toxicologie, Universite du Luxembourg, Luxembourg.

Copyright

(Copyright © 2010, Elsevier Publishing)

DOI

10.1016/j.jemermed.2008.10.023

PMID

19272738

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 mug/L) and cotinine peak levels (9092 mug/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.

Language: en