Nicotine may not have been the exact toxin, but it is close:


EPA Government Website 



Nicotine is an alkaloid contained in the leaves of many species of plants,

but is usually obtained commercially from tobacco. A 14% preparation of the

free alkaloid is marketed as a greenhouse fumigant. Significant volatilization of

nicotine occurs. Commercial nicotine insecticides have long been known as

Black Leaf 40. This formulation was discontinued in 1992. Other currently

available formulations include dusts formulated with naphthalene and dried

blood used to repel dogs and rabbits. Be aware of Green Tobacco Syndrome

from dermal absorption. Very little nicotine insecticide is currently used in the

United States, although old preparations of nicotine insecticides may still be

found on occasion.6 Today, most nicotine poisonings are the result of ingestion

of tobacco products and incorrect use of nicotine skin patches.


Nicotine alkaloid is efficiently absorbed by the gut, lung, and skin. Extensive

biotransformation occurs in the liver with 70-75% occurring as a first pass

effect. 7 Both the liver and kidney participate in the formation and excretion of

multiple end-products, which are excreted within a few hours. Estimates of the

half-life of nicotine range from about one hour in smokers to as much as two

hours in non-smokers.8,9

Toxic action is complex. At low doses, autonomic ganglia are stimulated.

Higher doses result in blockade of autonomic ganglia and skeletal muscle neuromuscular

junctions, and direct effects on the central nervous system. Paralysis and

vascular collapse are prominent features of acute poisoning, but death is often due

to respiratory paralysis, which may ensue promptly after the first symptoms of

poisoning. Nicotine is not an inhibitor of the cholinesterase enzyme.

Signs and Symptoms of Poisoning

Early and prominent symptoms of poisoning include salivation, sweating,

dizziness, nausea, vomiting, and diarrhea. Burning sensations in the mouth and

throat, agitation, confusion, headache, and abdominal pain are reported. If dosage

has been high, vascular collapse with hypotension, bradycardia or other

arrythmias, dyspnea then respiratory failure, and unconsciousness may ensue

promptly.6,10,11,12 In some cases, hypertension and tachycardia may precede hypotension

and bradycardia, with the latter two signs leading to shock.11,12 Seizures

may also occur.6,11 In one case of ingestion of a large dose of nicotine

alkaloid pesticide, the patient developed asystole within two minutes. He later

developed seizures and refractory hypotension.6

Confirmation of Poisoning

Urine content of the metabolite cotinine can be used to confirm absorption

of nicotine.


1. Skin decontamination. If liquid or aerosol spray has come in contact with

skin, wash the area thoroughly with soap and water. If eyes have been contaminated,

flush them thoroughly with clean water or saline. If irritation persists,

obtain specialized medical treatment.

If symptoms of poisoning appear during exposure to an airborne nicotine

insecticide, remove the person from the contaminated environment immediately,

wash any skin areas that may be contaminated, then transport the victim to the

nearest treatment facility. Although mild poisoning may resolve without treatment,

it is often difficult to predict the ultimate severity of poisoning at the onset.

2. Pulmonary ventilation. If there is any indication of loss of respiratory

drive, maintain pulmonary ventilation by mechanical means, using supplemental

oxygen if available, or mouth-to-mouth or mouth-to-nose methods if necessary.

Toxic effects of nicotine other than respiratory depression are usually

survivable. The importance of maintaining adequate gas exchange is therefore


3. Gastrointestinal decontamination. If a nicotine-containing product has

been ingested recently, immediate steps must be taken to limit gastrointestinal

absorption. If the patient is fully alert, immediate oral administration of activated

charcoal as outlined in Chapter 2 is probably the best initial step in management.

Repeated administration of activated charcoal at half or more the

initial dosage every 2-4 hours may be beneficial. Since diarrhea is often a part

of this poisoning, it is usually not necessary or appropriate to administer a

cathartic. Do not administer syrup of ipecac.

4. Cardiac monitoring. Monitor cardiac status by electrocardiography, and

measure blood pressure frequently. Cardiopulmonary resuscitation may

be necessary. Vascular collapse may require administration of norepinephrine

and/or dopamine. Consult package inserts for dosages and routes of administration.

Infusions of electrolyte solutions, plasma, and/or blood may also be

required to combat shock.

5. Atropine sulfate. There is no specific antidote for nicotine poisoning. Severe

hypersecretion (especially salivation and diarrhea) or bradycardia may be

treated with intravenous atropine sulfate.

Dosage of Atropine Sulfate:

Adults and children over 12 years: 0.4-0.5 mg slowly IV, repeated every

5 minutes if necessary.

Children under 12 years: 0.01 mg/kg body weight, slowly IV, repeated

every 5 minutes if necessary. There is a minimum dose of 0.1 mg.

6. Convulsions should be controlled as outlined in Chapter 2. If the patient

survives for four hours, complete recovery is likely.


Acute nicotine toxicity

"Acute nicotine toxicity is associated with over stimulation of nicotinic receptors. Burning in the throat with nausea and vomiting occurs quickly after ingestion. More toxic manifestations include cardiac tachyarrythmias, seizures, and hypertensive crisis. The lethal dose of nicotine in adults is from 0.5 to 1.0 mg/kg of body weight or a total dose of 30--60 mg. Toxic symptoms might been seen at doses as low as 2--5 mg of nicotine; however, persons might have widely different levels of tolerance to the toxic effects of nicotine. Small children might develop symptoms after exposure to as little as 1 mg of nicotine. Nicotine is used in a limited number of pesticides because of its toxic properties; nine nicotine-containing pesticides are registered for use in Michigan, and none of the product labels list nicotine at more than 14%. Black Leaf 40 contained 40% nicotine, and the EPA canceled its product registration in 1992 because of its toxicity."  


2.2 Summary of clinical effects

Burning sensation in the mouth and throat, salivation, nausea, abdominal pain, vomiting and diarrhoea. Gastrointestinal reactions are less severe but can occur even after cutaneous and respiratory exposure.  

Systemic effects include: agitation, headache, sweating, dizziness, auditory and visual disturbances, confusion, weakness and lack of coordination. A transient increase in blood pressure, followed by hypertension, bradycardia, paroxysmal atrial fibrillation, or cardiac standstill may be observed.  

In severe poisoning, tremor, convulsions and coma occur. Faintness, prostration, cyanosis and dyspnoea progress to collapse. Death may occur from paralysis of respiratory muscles and/or central respiratory failure. 

>>> This Intellectual Property was stolen from a website, and used without the author's permission <<<

Author's note:

This would account for a person possibly going into a bathroom.  It might not be bulimia - it would be a purging of toxins. A person might also have to be de-fibbed several times, and have the symptoms mentioned above. They might later have a high or off-the-chart rbc count in their urine. Who'd think of screening for nicotine?

A BP lowering drug could be added to cause an immediate event and to throw off the diagnosis. The purging would also get rid of most of the GI evidence - BUT - I recall reading that a certain patient presented with GI sounds.

It would be very dangerous for a person to drink a glass of ice tea with nicotine in it.