Signs, Symptoms, and Treatment of Nicotine Overdose
Nicotine is a highly addictive central nervous system stimulant.1 When ingested, it gives you focus and concentration, accelerates your heart and breathing rate, and increases blood pressure. It is linked to raised alertness, the sensation of euphoria, and a sensation of being relaxed.2
Once in the habit of using nicotine in any form, it is difficult to stop. According to Medical News Today, it is at least as hard to give up as heroin.
Unlike heroin, however, it is much harder to achieve a lethal dose of nicotine. In fact, it's extremely rare to do so. The vast majority of reported cases of nicotine poisoning or overdose have not been from people using the drug for recreational purposes, but from cases of accidental ingestion of nicotine products (especially for kids), from contact with tobacco leaves, or from its use as a pesticide (which has been outlawed in the United States since 2014).3
That said, it is possible to overdose on nicotine, which for the purposes of this article means ingesting a lethal dose. Cigarettes, gum, patches, and e-liquid containing nicotine could all potentially cause an overdose if taken in large enough amounts. Usually, this is seen in the case of children or pets accidentally ingesting these products.
What most people are more likely to experience is a series of unpleasant side effects that result from ingesting a larger-than-comfortable dosage of nicotine.
Note: You should never drink e-liquid, and never ever combine smoking with patches, or gum, or any other combination of nicotine-containing products. Doing so can be very dangerous. For children and pets, accidental ingestion of these items can be very serious. Keep them away and out of reach.
How Much Is Too Much Nicotine?
A likely figure for a lethal dose of nicotine for adults has been estimated to be between 500-1000 mg.4 In contrast, the average U.S. cigarette delivers between one and two mg of nicotine, though this amount differs by brand and type.5 It would take smoking over 100 cigarettes in a short time period to ingest a lethal dose.
You don't have to smoke 100 cigarettes to start feeling sick, however. Even at dosages much, much less than a lethal dose, nicotine can cause some very unpleasant side effects.
Nicotine Sickness (Nic Sick)
Nicotine sickness is not life-threatening, just very unpleasant. Luckily, because it's so unpleasant, it prevents people from continuing to ingest nicotine and reaching toxic doses. Its symptoms often include:
- Racing heart
- Sweating or clamminess
The amount of nicotine a person can take without feeling any ill side effects varies drastically due to:
- Prior nicotine usage
- Whether or not they've eaten recently
- Other biological and behavioral factors
It can be easy to accidentally take an uncomfortable dose of nicotine if you've started to use it again after a period when you weren't using it, when you're using a new delivery method (i.e. vaping), or if you're trying a new product (like a new cigar or new e-cig liquid).
If you're experiencing nicotine sickness, and unless you've ingested a large amount of nicotine in a highly unusual manner (as in the above scenarios), you're going to be okay. There are some things you can do to help the discomfort.
- Stop taking the product that you're taking the instant that you feel nauseous or otherwise unwell. If you've spilled any e-cig liquid on your hands or body, wash the affected area with soap and water.
- Drink several glasses of water — this may help dilute the concentration of nicotine in your body.
- Eat sugar — some people swear by eating several spoonfuls of sugar, drinking a Coke, drinking juice, or eating milk chocolate to counteract nicotine sickness. The logic behind this, which seems to be supported by medical evidence as well as anecdotal evidence,6,7 is that nicotine causes a metabolic response which leads to rapidly fluctuating blood sugar levels, which can lead to nausea. Eating sugar helps bring your blood sugar levels back up.
- Eat something in general — if you can keep food down, eating something light and easy to digest (like toast, rice, bananas, or an apple) may help ease nausea as well.
The effects can last from between an hour to several hours, though there shouldn't be any lingering side effects after that.
Unfortunately, though cases of nicotine sickness are well-documented by users, it seems this has not been well studied by the medical community. Please be careful with your nicotine use and observe your body carefully, especially when changing products.
Do you currently use any nicotine products?
Signs and Symptoms of Nicotine Poisoning
Since lethal doses of nicotine for adults is somewhere between 500 and 1000 milligrams, most nicotine poisoning cases occur in rare circumstances, such as in high industrial exposure to the chemical.
As mentioned above, accidental ingestion of high-nicotine products by children and pets is one of the most common causes nicotine poisoning.8
The lethal dose of nicotine is between 500 and 1000mg. (see: Mayer, Archives of Toxicology)
When smoking a cigarette, between one and two mg of nicotine enter the bloodstream.
There are many ways for nicotine to enter the bloodstream, from smoking regularly or vaping e-cigarettes to using chew, patches, or gum. Nicotine can also enter the bloodstream through direct skin contact. Note: Never use nicotine patches other than as directed, and do not combine their use with smoking or other nicotine containing products. Though this is unlikely to cause any kind of permanent damage, it could result in nicotine sickness.
Nicotine only makes up approximately 0.6–3.0% of dry weight in tobacco, which is the main ingredient of a tobacco cigarette. On average, a cigarette manufactured in the United States contains about 9 mg of nicotine, but this is not the amount of nicotine that is ingested by a smoker. When cigarettes are burned, the smoke is inhaled by the user into the lungs, where the nicotine is absorbed into the bloodstream. The amount of nicotine actually entering the body varies, though it is typically between one and two mg.5
Symptoms of Overdose
Poisoning from nicotine is generally seen in two stages. The first happens within the first 15 minutes to an hour after the poisoning, and the second occurs between 30 minutes and four hours after ingestion.9
- Abdominal pain
- Tachycardia, or a dangerously fast heart rate
- Ataxia, or a lack of muscle coordination that may affect speech, eye movements, and the ability to swallow or walk
- Shaking and tremors
Some of these are similar to nicotine sickness, though, in the case of a true overdose, they will be more severe.
- Bradycardia (slow heart rate)
- Hypotension (low blood pressure)
- Central nervous system depression
- Shallow breathing
- And finally, breathing and respiratory failure
Nicotine Overdose? Call Poison Control!
If you or especially a child has swallowed any kind of tobacco or nicotine product or spilled it on your skin and you suspect a nicotine overdose, call Poison Control at 1-800-222-1222 (U.S.) Have the following information ready when you call:
-Patient's age and weight
-Name of the product
-Amount that was ingested
-When it was ingested
What to Do If You Think You or Someone Else Has Overdosed
For a mild nicotine overdose, follow the steps given above for treating nicotine sickness.
When a nicotine overdose is serious or life-threatening, however, you need to take a few more precautionary measures.9
Call Poison Control (U.S.: 800-222-1222) if you suspect that you or someone, especially a child, has swallowed any kind of tobacco or nicotine product or gotten liquid nicotine in their eye or spilled it on their skin. If you can, have the following information ready when you call:
- Patient's age and weight
- Name of the product
- Amount that was ingested
- When it was ingested
If the poisoned person can't wake up, has a seizure, or can't breathe, call 911.
Do not try to make them throw up or give them antacids to settle the stomach. It is okay, however, to offer them water. They'll likely start vomiting on their own.
For nicotine in the eyes, rinse the eyes with warm water for at least 15 minutes. And where it's gotten on the skin, wash the area with warm soap and water.
If You Go to the Emergency Room
In the emergency room, you may receive:10
- Activated charcoal
- Medications to control the symptoms
- A tube through the nose or mouth to wash out the contents of the stomach
If you catch the poisoning in time, the outlook is generally positive with no long-term side effects.
Wishing You Safety and Good Health
All recreational drug use needs careful attention, especially in households with children or pets that could be affected. Please be careful when using nicotine and make sure those around you are safe too.
- D'Souza, Manoranjan S., MD, Ph.D., and Athina Markou, Ph.D. "Neuronal Mechanisms Underlying Development of Nicotine Dependence: Implications for Novel Smoking-Cessation Treatments." July 2011. Addiction Science and Clinical Practice. Accessed July 7, 2017.
- Nordqvist, Christian. "Nicotine: Facts, Effects, Nicotine Addiction." December 1, 2015. Medical News Today. Accessed July 7, 2017.
- "Nicotine Poisoning?" (n.d.) Columbia University: Go Ask Alice. Accessed July 7, 2017.
- Mayer, Bernd. "How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century." January 2014. Archives of Toxicology. Accessed July 7, 2017.
- Brown, David. "Nicotine Up Sharply in Many Cigarettes." August 31, 2006. Washington Post. Accessed July 7, 2017.
- Mishra, Aseem, Pankaj Chaturvedi, Sourav Datta, Snita Sinukumar, Poonam Joshi, and Apurva Garg. "Harmful Effects of Nicotine." Jan - Mar, 2015. Indian Journal of Medical and Paediatric Oncology. Accessed July 7, 2017.
- "PSA: How to deal with a nicotine overdose in 3 easy steps." 2015. Reddit r/electronic_cigarette forum post. Accessed July 7, 2017.
- Chatham-Stephens, Kevin, Royal Law, Ethel Taylor, Stephanie Kieszak, Paul Melstrom, Rebecca Bunnell, Baoguang Wang, Hannah Day, Benjamin Apelberg, Lee Cantrell, Howell Foster, and Joshua G. Schier. "Exposure Calls to U. S. Poison Centers Involving Electronic Cigarettes and Conventional Cigarettes—September 2010–December 2014." June 28, 2016. Journal of Medical Toxicology. Accessed July 7, 2017.
- Medically reviewed by Melinda Ratini, DO, MS. "Nicotine Poisoning: Can You Overdose?" August 23, 2016. WebMD. Accessed July 7, 2017.
- "Nicotine Poisoning." January 30, 2013. NYTimes. Accessed July 7, 2017.
© 2013 Rebecca