Nicotine Poisoning

Nicotine Poisoning

Nicotine can be lethal to children in doses as small as 10 milligrams.

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The human toxicity of nicotine has become increasingly relevant in the past couple of years through the marketing of new nicotine-containing products, such as smokeless tobacco and liquids for electronic nicotine delivery systems (electronic cigarettes) that are freely available in most countries.

Standard textbooks, databases, and safety sheets consistently state that the lethal dose for adults is 60 mg or less (30–60 mg), leading to safety warnings that ingestion of five cigarettes or 10 ml of a dilute nicotine-containing solution could kill an adult. The 60-mg dose would correspond to an oral LD50 of around 0.8 mg/kg, a dose that is considerably smaller than the values determined for laboratory animals, which are ranging from 3.3 (mice) to more than 50 mg/kg (rats) (Hayes 1982).

Although an LD50 of 0.8 mg/kg would implicate that the toxicity of nicotine is similar to or even higher than that of cyanide, fatal nicotine intoxications are relatively rare, and there are countless records of subjects who survived consumption of nicotine in amounts far higher than 60 mg (Larson et al. 1961). The most drastic example is probably a survival of a suicide attempt with 4 g of pure nicotine (Schmidt 1931). While this is certainly an exceptional case, in which the amount of bioavailable nicotine was markedly reduced by vomiting, ingestion of tobacco or nicotine gums at doses up to 6 mg/kg nicotine was reported to evoke symptoms of intoxication without causing death (Malizia et al. 1983; Smolinske et al. 1988). These and many other literature reports on nonfatal nicotine intoxications are hardly compatible with a lethal dose of 60 mg or less.

The mismatch between the generally accepted lethal dose and documented cases of nicotine intoxication raises the question of the genuine source of the 60-mg dose. Literature and Internet searches provided circular and often misleading references to databases or textbooks, which either simply state the dose without reference or refer to another textbook and so on.

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