Internet suicide guidelines: report of a life-threatening poisoning using tobacco extract.
BACKGROUND
Severe nicotine intoxication occurred in a patient after ingestion of a tobacco extract made from a recipe found on a freely available Internet site.


OBJECTIVE
To determine the levels of nicotine and cotinine in the plasma of a patient who tried to commit suicide by drinking a highly concentrated tobacco extract.


METHODS
A 67-year-old man tried to commit suicide by following guidelines found on an Internet site. He soaked 300 grams of tobacco for 3 days in water, evaporated most of the extract, and drank the rest of it. He felt sick immediately, with the following signs: respiratory depression, hypothermia, hypersalivation, bradycardia, and myoclonic jerks. Soon after the ingestion he vomited most of the extract. Toxicological analysis revealed potentially life-threatening nicotine and cotinine serum concentrations. Surprisingly, nicotine peak levels (322 microg/L) and cotinine peak levels (9092 microg/L) were reached more than 3 h after ingestion of the extract. Estimated nicotine and cotinine half-lives were 200 min and 1185 min, respectively. Treatment consisted of gastric lavage, ventilation, and monitoring of vital functions. The patient recovered and was discharged from the Emergency Department 4 days later without sequelae.


CONCLUSIONS
Nicotinergic intoxication is not always easy to recognize, and without clues from the patient and the toxicologic analysis, might well have been missed in the present case.
Schneider
Serge
S
Laboratoire National de Santé, Division de Toxicologie, Université du Luxembourg, Luxembourg.
Diederich
Nico
N
Appenzeller
Brice
B
Schartz
Anne
A
Lorang
Christiane
C
Wennig
Robert
R
D000284:Administration, Oral; D000368:Aged; D003866:Depressive Disorder; D006801:Humans; D020407:Internet; D008297:Male; D009538:Nicotine / Q000008:administration & dosage / Q000506:poisoning*; D010936:Plant Extracts / Q000008:administration & dosage / Q000506:poisoning*; D013406:Suicide, Attempted; D014026:Nicotiana / Q000506:poisoning*
D010936:Plant Extracts; D009538:Nicotine