Clinical presentation

The symptoms of nicotine poisoning are due to excessive stimulation of nicotinic cholinergic receptors, which causes a cholinergic toxidrome.

Nicotine is rapidly absorbed. A short-lived early phase of stimulation is followed by a more prolonged phase of inhibition of the nicotinic cholinergic receptors.

Effects of nicotine poisoning include:

• central nervous system (CNS) effects
  • early—transient agitation, muscle fasciculations, confusion, self-limiting seizures
  • late—mydriasis, muscular weakness and paralysis, lethargy, CNS and respiratory depression, coma
• cardiovascular effects
  • early tachycardia and hypertension, progressing to hypotension and bradycardia
  • other arrhythmias (uncommon)
• respiratory effects—respiratory muscle paralysis, bronchorrhoea, bronchoconstriction
• gastrointestinal effects—nausea, vomiting, diarrhoea, abdominal pain, hypersalivation
• other effects—pallor.