title: A case of life-threatening rectal administration of moist snuff.
abstract: METHODS
  We report a case of self-administration of 75 sachets of moist snuff rectally in a previously healthy, 42-year-old man. He presented with symptoms of nausea, discomfort, and dizziness. He had dry and warm skin, a pulse rate of 53 bpm, a mean arterial blood pressure of 135 mmHg and fluctuations in consciousness. The patient was treated with mechanical ventilation because of respiratory insufficiency. No specific anti-nicotinergic treatment was given. Plasma levels of the nicotine metabolite cotinine were 8,691 μg/L 7 h after admittance and 9,814 μg/L after 12 h. Levels of cotinine in the urine were above >50,000 μg/L. The patient developed a mild pneumonia, but he was uneventfully extubated after 12 h of mechanical ventilation. All physiological parameters were restored and he was discharged from hospital after 36 h.
  
  
  CONCLUSIONS
  Excessive rectal administration of moist snuff may be life threatening. Patients may require intensive care. Long-term sequelae were not seen in this case.
authors.affiliation: Surgical Sciences, Anesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. kai.knudsen@aniv.gu.se
authors.forename: Kai
authors.initials: K
authors.lastname: Knudsen
authors.forename: Morten
authors.initials: M
authors.lastname: Strinnholm
mesh_terms: D000285:Administration, Rectal; D000328:Adult; D006801:Humans; D008297:Male; D009538:Nicotine / Q000506:poisoning; D014030:Tobacco, Smokeless / Q000506:poisoning*
chemical_list: D009538:Nicotine