Frequency and outcomes of accidental ingestion of tobacco products in young children

Unintentional fatal toxicity due to nicotine chewing gum: A case report

RATIONALE

Since tobacco contains numerous harmful substances, besides nicotine, which is addictive, smoking cessation products and tobacco alternatives, such as electronic (e-) cigarettes, nicotine chewing gums, and patches, are being widely used. Nicotine gums are consumed orally. The nicotine from the gum is absorbed at a slower rate than that from e-cigarettes, and the former remains in the bloodstream for a longer period. In addition, the maximum number of daily doses is high, and it can be purchased without a doctor's prescription in many countries.

PATIENT CONCERNS

A 29-year-old male patient consumed 5 2-mg nicotine gums at a time, twice a day, for 4 days (total amount: 70 mg). However, he visited the emergency unit with the chief complaint of involuntary limb movements after consuming an additional 15 gums 3 hour before the visit. At admission, his consciousness was clear, although 2 hour later, he experienced sudden loss of consciousness with worsening hypoxia and respiratory acidosis.

DIAGNOSIS

The patient's vital signs were stable at the time of admission, and blood test results showed no specific findings other than a white blood cell count of 14,800/µL, lactate level of 6.4 mmol/L, and prolactin level of 119.02 ng/mL. In addition, chest radiography and head computed tomography scans showed no acute phase abnormalities. Two hours later, he experienced loss of consciousness and respiratory failure, and the results of blood tests performed at this time showed that his blood cotinine level was 3491 ng/mL.

INTERVENTIONS

Supportive treatment, including endotracheal intubation followed by mechanical ventilation, was provided.

OUTCOME

The patient's vital signs stabilized 3 days after treatment, and his consciousness and respiratory status had improved; therefore, mechanical ventilation was stopped. His condition was stable for the next 2 days, and he was discharged on the fifth day.

LESSONS

Acute respiratory exacerbation due to nicotine poisoning (from levels exceeding the lethal dose of 30-60 mg) was observed, although the gums were consumed over several days. Patients with nicotine poisoning may show acute respiratory failure and should be monitored carefully. Further studies are required to determine the toxic effects of nicotine replacement therapies.

Knowledge and attitude of children safety at home among population in Saudi Arabia

Background:

Unintentional injury to children at home is a public health problem and it is a significant cause of death and disabilities. It accounts for 40% of all child deaths. To our knowledge, there have been no similar studies done on Arabic countries that show the prevalence of home injuries among children.

Aim:

We aimed to assess the adults’ knowledge and attitude toward child safety at home in Saudi Arabia.

Methods:

A cross-sectional study was conducted among 1,301 participants, during August 2017, who are older than 18 years old and have at least one child in the family. Data were collected by an online questionnaire assessing the believes, knowledge, and behavior of the participants. Analysis was carried out using IBM SPSS Software version 21, using descriptive analysis, t-test, and one-way ANOVA.

Results:

It was found that gender, age, marital status, employment status, and the type of accommodation played key roles in the awareness of children safety at home, the study showed that females and age group above 25, married, employees, and those who lived in flats had more awareness than the other groups, respectively.

Conclusion:

The majority of the population had good awareness about children’s safety at home. Despite the good level of awareness, more public health education is recommended to improve the awareness and the prevention methods of these injuries.

Tobacco-related Poison Events Involving Young Children in the US, 2001-2016

Objective

In this paper, we describe trends in tobacco-related poison exposure calls (calls) involving young children in the US.

Methods

Data were from the National Poison Data System between January 1, 2001 and October 31, 2016. We analyzed data on calls involving children younger than 5 years old. We describe trends in calls over time and call frequency by age, tobacco product type, level of care, and other characteristics of calls.

Results

During 2001-2016, there were 123,876 calls involving young children. During the study period, calls increased for most product types; e-cigarette-related calls increased from 7 in 2010 to 2558 in 2015. In calls with information on level of care (92.2%), 278 children were admitted to an intensive care unit, 497 were admitted to a hospital noncritical care unit, and 19,834 were treated and released.

Conclusions

Tobacco-related poison events commonly occur in the US and can have serious health consequences. More than 123,000 events among young children were reported during 2001-2016, but this likely represents a small portion of actual tobacco-related poison events due to underreporting. It is critical to continue to monitor tobacco-related poison events and develop strategies to prevent tobacco-related harm.

Nicotine and Tobacco as Substances of Abuse in Children and Adolescents

Nicotine is the primary pharmacologic component of tobacco, and users of tobacco products seek out its effects. The highly addictive nature of nicotine is responsible for its widespread use and difficulty with quitting. This technical report focuses on nicotine and discusses the stages of use in progression to dependence on nicotine-containing products; the physiologic characteristics, neurobiology, metabolism, pharmacogenetics, and health effects of nicotine; and acute nicotine toxicity. Finally, some newer approaches to cessation are noted.

Accidental ingestion of E-cigarette liquid nicotine in a 15-month-old child: an infant mortality case of nicotine intoxication

Electronic cigarettes are novel tobacco products that are frequently used these days. The cartridge contains liquid nicotine and accidental poisoning, even with a small oral dose, endangers children. We present here a mortality case of a 15-month-old child who ingested liquid nicotine mistaking it for cold medicine. When the emergency medical technicians arrived, she was found to have pulseless electrical activity. Spontaneous circulation was restored after approximately 40 minutes of cardiopulmonary resuscitation. The cotinine level in her urine was 1,716 ng/mL. Despite intensive supportive care, severe anoxic brain injury was found on computed tomography and the child ultimately died. This fatality highlights the need for public health efforts to minimize such accidents.

Mutagenicity of cigarette butt waste in the bacterial reverse mutation assay: The protective effects of β-caryophyllene and β-caryophyllene oxide

Cigarette filters pose a serious litter and toxic waste disposal problem, because of their not biodegradability and to the leaching of toxins in the environment. Therefore, cigarette butts need to be manipulated as special waste, with potential risks to human health and environment. In the present study, the genotoxic potential of a methanol extract from commonly discharged cigarette butts (CBE) was evaluated in the bacterial reverse mutation assay on Salmonella typhimurium TA98 and TA100 and Escherichia coli WP2uvrA strains, both in the absence and presence of the S9 exogenous metabolic activator. Furthermore, the ability of the natural sesquiterpenes β-caryophyllene (CRY) and β-caryophyllene oxide (CRYO) to inhibit the mutagenicity of CBE was studied as a possible preventive strategy. In order to identify the potential antimutagenic mechanisms, three different protocols (pretreatment, cotreatment, and posttreatment) were applied. CBE showed to increase the number of revertant colonies in all the strains tested in presence of S9, so resulting mutagenic. In the antimutagenicity assay, both CRY and CRYO significantly reduced the revertant colonies induced by CBE, although with different potency and specificity. For both sesquiterpenes, the antimutagenicity was strong in all experimental conditions, except for the cotreatment of CRY with CBE in WP2uvrA, which produced a moderate inhibition. Both desmutagenic and bioantimutagenic mechanisms seem to be involved in the antimutagenicity of the test substances. Taking into account the potential genotoxicity of cigarette butts, CRY and CRYO appear as possible further candidates as environmental decontaminants against this hazardous waste. © 2015 Wiley Periodicals, Inc. Environ Toxicol 31: 1319-1328, 2016.