Resident Presenter: Ivan Cometa
Topic: Acute Nicotine overdose
13 yo female presented after unintentional overdose (estimated 4ml e-cigarette liquid solution) one hour prior to arrival. She presented agitated, tachycardic, & tachypneic with diffuse abd pain, tremors, & fasciculations. She became bradycardic & borderline hypotensive during her ED course which were managed with atropine & IVF. Patient was admitted to the ICU for one day for supportive care & later discharged.
- E-cigarette liquid solutions are very concentrated & ingestions may cause nicotine toxicity
- Nicotine poisoning resembles the cholinergic toxidrome
- Presentation is biphasic:
- Early symptoms include “SLUDGE”, bronchorrhea, tachypnea, tachycardia, hypertension
- Late symptoms include respiratory depression, apnea, bradycardia, hypotension
- Management is principally supportive
- Initial stimulatory effects are largely adrenergically driven & may be brief. Adrenergic antagonists should be avoided as they may worsen symptoms during the late phase.
- Atropine is useful in the management of cardiopulmonary depression & symptoms of excessive parasympathetic stimulation (SLUDGE).
- Initial Dose: 0.5-1 mg in adults | 0.02 mg/kg in children