Nicotine, found naturally in tobacco plants, is the chemical responsible for the addictive nature of cigarettes, cigars, and many e-cigarettes.

Until recent years, nicotine poisoning was a relatively rare occurrence and tended to be linked to exposure to insecticides containing the chemical. However, the popularity of vaping or e-cigarettes has seen an increase in reported cases.

Both adults and children can be affected by nicotine, with over 50 percent of cases of nicotine exposure reported to the American Association of Poison Control Centers (AAPCC) in 2014 occurring in children under 6 years of age.

Fast facts on nicotine poisoning:

  • Nicotine poisoning results from too much nicotine in the body.
  • Vaping and liquid nicotine are the most common forms to cause nicotine poisoning in adults.
  • Eating cigarettes or consuming liquid nicotine is the most common method of poisoning in children.
  • The instances of nicotine poisoning have risen steadily as alternative forms of consuming it gain popularity.

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Cigarettes and nicotine gum both contain nicotine, which in large doses may cause nicotine poisoning.

Nicotine is present in:

  • cigarettes
  • cigars
  • e-cigarettes (vaping)
  • liquid nicotine
  • nicotine gum
  • nicotine patches
  • nicotine lozenges
  • chewing tobacco
  • pipe tobacco
  • snuff
  • some insecticides
  • tobacco plants

Nicotine poisoning tends to occur in 2 stages.

Within the first 15 to 60 minutes following exposure, symptoms are related to the stimulatory effects of nicotine and include:

  • excess saliva in the mouth
  • feeling nauseous
  • stomach ache
  • vomiting
  • loss of appetite
  • dehydration
  • eye irritation
  • headache
  • dizziness
  • tremors
  • anxiety and restlessness
  • confusion
  • sweating
  • cough
  • rapid breathing
  • increased heart rate
  • elevated blood pressure

Following this stage, the body begins to wind down. Nicotine’s depressor effects appear within a few hours. These include:

  • low blood pressure
  • slow heart rate
  • shallow breathing
  • diarrhea
  • fatigue
  • weakness
  • pale skin

In extreme cases, symptoms include:

  • seizures
  • coma
  • breathing difficulties
  • respiratory failure

Serious or fatal nicotine overdoses can occur but are rare.

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E-cigarettes, alongside any forms of liquid nicotine, are some of the most common causes of nicotine poisoning.

Nicotine poisoning is essentially caused by overexposure to nicotine.

This is causes either through inhalation, ingestion, or absorption through the skin or eyes.

E-cigarettes and liquid nicotine are responsible for the majority of cases of nicotine poisoning.

How commonly is nicotine poisoning reported?

According to research by the Centers for Disease Control and Prevention (CDC), the number of calls to poison centers involving nicotine poisoning from these sources rose from 1 per month in September 2010 to 215 per month in February 2014. The number of calls regarding nicotine poisoning from traditional cigarettes did not change.

What forms of nicotine are most dangerous?

Children are most at risk of nicotine poisoning through eating cigarettes or nicotine-containing products, or drinking or touching liquid nicotine. Nicotine from e-cigarettes may be especially hazardous, as these products are not required to be childproof, and are available in flavors that appeal to children.

Adults who are unaccustomed to smoking and who try vaping are at greater risk of nicotine poisoning than adults who smoke regularly. Using a nicotine patch or chewing gum containing nicotine while smoking at the same time can also lead to nicotine overdose. Chewing or snorting tobacco tends to release more nicotine into the body than smoking.

Third-hand nicotine poisoning may also be an issue for adults, children, and pets. Vapors from e-cigarettes can stick to fabrics or other surfaces and then transfer to those who touch them.

A form of nicotine poisoning, known as Green Tobacco Sickness (GTS), can occur in those who harvest tobacco or work in tobacco processing factories.

Nicotine overdose depends on factors such as body weight and the source of the nicotine.

Researchers have frequently indicated that the lethal dose of nicotine for adults is 50 to 60 milligrams (mg), which prompted safety warnings stating that approximately five cigarettes or 10 milliliters (ml) of a nicotine-containing solution could be fatal.

However, the mortality rate from nicotine poisoning is extremely low, and some research suggests that it takes 500-1000 mg of oral nicotine to kill an adult.

Children are much more susceptible to the effects of nicotine, with consumption of a single cigarette shown to be enough to cause illness.

Nicotine affects the body in a variety of ways. It is both a sedative and a stimulant that impacts the heart, hormones, and digestive system.

Aside from the risk of nicotine poisoning, the primary risk associated with nicotine use is its addictive qualities. It is at least as difficult to quit nicotine as it is heroin. One study reports that consuming nicotine makes cocaine more addictive.

Many people who quit nicotine will experience withdrawal symptoms such as:

  • anxiety
  • cravings
  • depression
  • difficulty concentrating
  • irritability

Nicotine is most harmful when taken in quantities larger than those recommended (leading to nicotine poisoning) and when consumed in cigarettes or other products that contain a variety of chemicals that are detrimental to health including cigars.

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Nicotine poisoning will usually be treated in a hospital, and a ventilator may be used if the patient is having trouble breathing.

Treatment for nicotine poisoning is usually carried out at a hospital. The treatments administered will depend on the amount of nicotine ingested and the symptoms experienced.

Activated charcoal may be used to bind with the nicotine in the stomach and take it out of the body.

If the person is experiencing breathing difficulties, a ventilator will be used to deliver oxygen.

Other supportive treatments, including medications, are used to manage seizures, low blood pressure, and abnormal heart rates.

If someone is experiencing nicotine poisoning symptoms, it is important to seek emergency medical attention.

Follow the directions of the medical personnel and do not force the person to vomit or give them any food or liquids.

For nicotine that was absorbed through the skin, rinse the affected area immediately with water for 15 minutes.

The most effective way to prevent nicotine poisoning is to stop using cigarettes and other nicotine-containing products.

Other preventative measures include:

  • protecting the skin, especially when using liquids containing nicotine
  • safely storing nicotine products away from children and pets
  • correctly disposing of nicotine products – including cigarette butts and empty nicotine cartridges

People who wish to quit smoking or use of other nicotine products should consult their doctor for further information.

The outlook for those with nicotine poisoning depends on how much nicotine they have ingested and how quickly they seek treatment. With rapid medical treatment, most people make a full recovery without any long-term effects.

In rare cases, severe nicotine poisoning can be fatal.