2024-11-17

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Chubbyemu

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Patient CW by Cupcake Windle. Eric by Wolfgang Nelson. Mike by Mike Burling. PA Mike Burling. Review: Dr Katherine Johns

Opposite situations:

A Husband Was Found With Another Woman: /youtube/video/qNV5X-GBkR8

A Wife Put Drain Cleaner In Her Husband's Coffee: /youtube/video/uGv1xasBCmo

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Amanita muscaria By Onderwijsgek at nl.wikipedia, CC BY-SA 3.0 nl, https://commons.wikimedia.org/w/index.php?curid=1428517

Nicotine is a cholinomimetic, similar to the -stigmines and organophosphates. Increase in ACH increases parasympathetic activity from the Nicotinic Receptors. Expect cholinergic toxidrome, but with a caveat. One of which being that atropine would not be the antidote for this, given its activity on muscarinic acetylcholine receptors and not nicotinic. Atropine may be used for some respiratory symptoms.

If we look at nicotine as something that triggers rapid neural and neuromuscular transmissions, then we can understand the end goal of its presence being the mimic of excess acetylcholine.

Therefore, we could say that functionally, the end result of a toxicity is similar to an overdose of anti-acetylcholinesterase, but there is a biphasic action in the setting of extreme overdose. First it appears to have a stimulant effect, then it will look more like cholinergic excess afterwards.

In particular, nicotinic agonists, or just nicotine alone, paradoxically leads to a constellation of cholinergic + sympathomimetic findings, since nicotinic receptors are located on postganglionic nerves in both the sympathetic and parasympathetic nervous systems. The respiratory depression is what proves to be fatal.

These cases are patients who I, or my colleagues have seen. They are de-identified and many instances have been presented in more depth in an academic setting. These videos are not individual medical advice and are for general educational purposes only. I do not give medical advice over the internet.

References:

America's Poison Centers: E-CIGARETTES AND LIQUID NICOTINE. https://poisoncenters.org/track/ecigarettes-liquid-nicotine

Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Textbook.

Goldfrank's Toxicology. Textbook.

Physiology, Autonomic Nervous System. https://www.ncbi.nlm.nih.gov/books/NBK538516

Managing intoxications with nicotine-containing e-liquids. https://www.tandfonline.com/doi/full/10.1080/17425255.2022.2058930

Brain death following ingestion of E-cigarette liquid nicotine refill solution. https://onlinelibrary.wiley.com/doi/full/10.1002/brb3.1744

Nicotine poisoning-related deaths in Seoul Capital Area, Korea, 2014–2021. https://www.sciencedirect.com/science/article/abs/pii/S235200782200275X

The Emerging Method of .. by Electronic Cigarette Liquid: a Case Report. https://pmc.ncbi.nlm.nih.gov/articles/PMC5835582/

Fatal .. Attempt by Deliberate Ingestion of Nicotine-containing Solution in Childhood-onset Depression Mediated through Internet .. Guideline: A Case Report. https://pmc.ncbi.nlm.nih.gov/articles/PMC7519620/

Symptomatic bradycardia due to nicotine intoxication. https://pmc.ncbi.nlm.nih.gov/articles/PMC5885240/

American Cancer Society: Nicotine Replacement Therapy to Help You Quit Tobacco. https://www.cancer.org/cancer/risk-prevention/tobacco/guide-quitting-smoking/nicotine-replacement-therapy.html

https://www.sandiego.edu/smoke-free/documents/SmokelessTobacco.pdf

Cholinesterase Inhibitors Management Strategy: https://www.atsdr.cdc.gov/csem/cholinesterase-inhibitors/atropine.html

Synthesis of tetraethyl pyrophosphate (TEPP): from physician Abbot and pharmacist Riegel to chemist Nylen. https://pubmed.ncbi.nlm.nih.gov/26189307/

History of the Use and Epidemiology of Organophosphorus Poisoning. https://link.springer.com/chapter/10.1007/978-1-4471-5625-3_2

Cholinergic Mushroom Poisoning With a Detection of Muscarine Toxin in Urine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10332868/

Plasma nicotine levels after cigarette smoking and chewing nicotine gum. https://pubmed.ncbi.nlm.nih.gov/1268547/

How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. https://pmc.ncbi.nlm.nih.gov/articles/PMC3880486/

Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population. https://academic.oup.com/humrep/article/35/7/1693/5859935

Endogenous testosterone levels and smoking in men. The fifth Tromsø study. https://pubmed.ncbi.nlm.nih.gov/17163954/