Sept 17, 2001: What is the treatment of cigarette ingestion?

Nicotine is a bitter-tasking colorless liquid alkaloid that turns brown upon exposure to air.  Most nicotine in the US comes from the commonly cultivated tobacco Nicotiana tabacum.

Nicotine binds to nicotinic cholinergic receptors, causing stimulation then paralysis of the receptor.  Low doses of nicotine stimulate catecholamine release from the adrenal medulla and sympathomimetic effects predominate.

GI symptoms develop soon after ingestion of nicotine-containing products.  Abdominal pain and diarrhea may occur later.  In children ingesting cigarettes, smokeless tobacco, cigarette butts, tobacco spittle, nicotine gum, and nicotine patches, vomiting is the most frequent symptom. The rare development of serious toxicity in children is thought to be due to the protective effect of nicotine-induced vomiting.

Ingestion of less than one cigarette, less than 3 cigarette butts, and less than one piece of gum is not usually associated with toxicity.  Children who ingest more than the specified amount of these products should be observed.  If lethargy, twitching, or other non-GI symptoms develop within 4 hours of exposure, admission to a monitored bed should be considered. Symptoms usually resolve in 12-24 hours. 

If one patch has been ingested, the child should be evaluated in the ED.  Whole bowel irrigation should be considered for multiple patches.

Treatment is supportive.  Atropine should be administered for bronchorrhea, but this would be extremely rare in a child with nicotine ingestion.  ds