Death related to nicotine replacement therapy: A case report

Progressive nicotine poisoning by multiple transdermal nicotine patches

“…However, as the duration of TNP exposure increases, an inhibitory effect on nAChRs develops, which can cause life-threatening manifestations such as loss of consciousness, convulsions, respiratory muscle paralysis, fatal arrhythmia, and hypotension. 2,[5][6][7] In the present case, approximately 52-66 mg of nicotine was gradually absorbed for 5 h. As a result, the patient's clinical manifestations progressed from cholinergic symptoms to CNS depression symptoms after prolonged exposure to TNPs.…”

“…In addition, physicians must identify the commercial brand of TNP and the time of skin contact-there are differences in nicotine absorption rate and bioavailability among TNP products, and nicotine can be absorbed ex-tensively when a TNP has been applied for more than a few hours. 3,5,6) Toxicological assays of nicotine or cotinine levels are specific diagnostic tests for nicotine poisoning, but they may not be useful for initial diagnosis and treatment. Most samples are taken many hours after exposure, so the test results may not be correlated with symptom severity.…”

“…Intentional poisoning by multiple TNPs can cause fatal nicotine toxicity, even death. [2][3][4][5][6] Nicotine is primarily metabolized in the liver and excret-ed through the kidneys, and its plasma half-life is estimated to be less than 1-2 hours. The lethal dose of nicotine in adults is approximately 0.5-1.0 mg/kg, corresponding to a total dose of 30-60 mg. 6,7) Nicotine binds to nicotine-acetylcholine receptors (nAChRs), and its effect depends on the dose: small doses of nicotine stimulate the nAChRs, while higher doses inhibit them.…”

“…Respiratory failure due to respiratory muscle paralysis and inhibition of the respiratory center in the brain are the leading causes of death from acute nicotine poisoning. [5][6][7] In cases of acute nicotine poisoning by oral ingestion or intravenous injection, life-threatening conditions can occur within a few minutes. 8,9) However, TNPs have different pharmacokinetic properties and deliver nicotine gradually with no rapid uptake, so nicotine poisoning by multiple TNPs may have different clinical features.…”

Nanonaringenin and Vitamin E Ameliorate Some Behavioral, Biochemical, and Brain Tissue Alterations Induced by Nicotine in Rats

“…Nicotine promotes oxidative stress, implicates in several brain dysfunction, and prompts neurodegeneration. Experimental animal exposure to nicotine provokes oxidative stress and histopathological alterations due to diminishing the structural integrity and function of the brain [ 115 , 116 ]. Peroxidizable fatty acids, which are present abundantly in neuronal membranes, are highly vulnerable to lipid peroxidation [ 117 ], which finally leads to the liberation of oxidative markers such as MDA and 4-hydroxynonenal [ 9 ].…”