What are the symptoms of nicotine toxicity in children?

Symptoms of Nicotine Toxicity in Children

Nicotine toxicity in children presents with severe symptoms including weakness, headache, nausea, vomiting, dizziness, abdominal cramps, breathing difficulty, pallor, diarrhea, chills, fluctuations in blood pressure or heart rate, seizures, increased perspiration, and excessive salivation. 1

Common Symptoms by System

Gastrointestinal

• Nausea and vomiting 1, 2
• Abdominal cramps 1
• Diarrhea 1, 2

Neurological

• Headache 1
• Dizziness 1, 2
• Seizures 1
• Weakness 1, 2

Cardiovascular

• Fluctuations in blood pressure 1
• Irregular heartbeat or palpitations 2
• Rapid heartbeat 2
• Bradycardia (in some cases) 1

Dermatological/Other

• Pallor 1
• Increased perspiration 1
• Excessive salivation 1
• Chills 1
• Breathing difficulty 1

Routes of Exposure and Specific Presentations

Dermal Exposure (Green Tobacco Sickness)

• Common in children working on tobacco farms 1
• Caused by dermal absorption of nicotine from moist tobacco plants 1
• Symptoms may include all of the above, with one child reporting feeling "like I was going to die" 1

Ingestion of Nicotine Products

• Particularly dangerous with concentrated e-cigarette liquids 3
• Even small amounts can be lethal to young children 3
• Reference levels for toxicity:
  • Non-lethal dose potentially requiring medical care: 0.2 mg per kg 3
  • Non-lethal dose not requiring medical care: 0.04 mg per kg 3
  • Lethal dose: 1-14 mg per kg in children under 5 years 3

Transdermal Patch Exposure

• Symptoms occur with estimated nicotine dose ≥0.10 mg (≥0.01 mg/kg body weight) 4
• May cause gastrointestinal distress, weakness, dizziness, or localized rashes 4

Severity and Outcomes

Mild to Moderate Toxicity

• Gastrointestinal symptoms (nausea, vomiting, diarrhea) 2
• Dizziness 2
• Weakness 2

Severe Toxicity

• Respiratory failure 5
• Cardiovascular arrest 6
• Seizures 1
• Death (rare but documented) 7

Special Considerations

Age-Related Vulnerability

• Children under 5 years are particularly vulnerable to nicotine poisoning 3
• Even small amounts of nicotine-containing products can cause significant toxicity 2

E-cigarette Liquid Concerns

• Highly concentrated solutions (3-72 mg/mL) pose extreme danger 3
• As little as 0.5-2 mL of highly concentrated solution (72 mg/mL) could be lethal 3
• One documented fatality in a 15-month-old who ingested e-cigarette liquid 7

Management Considerations

• Immediate contact with Poison Control Center for any suspected exposure 2
• Symptoms may progress rapidly from mild to severe 5
• Supportive care including respiratory support may be necessary 5
• Child-resistant packaging and safe storage are critical preventive measures 3