see: [RCH - Nicotine Poisoning](https://www.rch.org.au/clinicalguide/guideline_index/nicotine_poisoning/), [Austin - Nicotine](x-devonthink-item://BB65E1F6-232B-4DAF-8A43-ACEB6C7AB415) see also: [[Cholinergic syndrome]] News: [nicotine pouch poisoning ↑ 763%](https://www.statnews.com/2025/07/14/reports-of-young-children-accidentally-eating-nicotine-pouches-rose-763-percent-study/) > minimum lethal dose is ≥ 0.5mg/kg ## Risk assessment Children need assessment who: - had any amount of liquid nicotine - >1 whole cigarette - >3 butts - any symptomatic patient - any pts with deliberate self-poisoning doses: | source | nicotine (mg) | | --------------- | ------------- | | cigarette | 13-30mg | | cig butt | 5-7 mg | | nicotine gum | 2-4 mg | | nicotine patch | 36 - 114mg | | liquid nicotine | 0 - 36 mg/mL | ## Clinical signs **early** < 1 hour - Gastro - N/V, abdo pain, salvation - CVS - tachycardia, HTN - resp - SOB, bronchorrhoea, bronchoconstriciton/wheeze - neuro - agitation, fasiculation, seizures **later in larger exposures** 1-4 hours - CVS - bradycardia, arrhythmia, hypotension, shock - resp - hypponea, apnoea - neuro - lethargy, muscle paralysis, stupor, coma ## Tx - standard supportive care - hypotension, symptomatic bradycardia, resp failure treated "per standard resus guidelines" - fluid bolus 10-20 ml/kg crystaloid - [[atropine]] for symptomatic bradycardia 0.6mg (child 0.02 mg/kg ; max dose 1.8 mg) - seizures: benzos - rarely activated charcoal unless high risk patients and present early -- d/w tox ## dispo - monitor 4 hours; asymptomatic or improved gastro sx only can d/c - admit all children with signs or symptoms of a larger exposure and for adolescent patients with an intentional overdose