Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 8 ( August, 2020 ) > List of Articles

CASE REPORT

Fatal Suicidal Attempt by Deliberate Ingestion of Nicotine-containing Solution in Childhood-onset Depression Mediated through Internet Suicide Guideline: A Case Report

Ashwini Kamble, Praveen Khairkar, Sri Prakash Kalantri, Sneh Babhulkar

Keywords : Acute encephalopathy with biphasic seizures and restricted diffusion, Children, Intensive care, Molecular mechanism, Nicotine toxicity, Suicidality

Citation Information : Kamble A, Khairkar P, Kalantri SP, Babhulkar S. Fatal Suicidal Attempt by Deliberate Ingestion of Nicotine-containing Solution in Childhood-onset Depression Mediated through Internet Suicide Guideline: A Case Report. Indian J Crit Care Med 2020; 24 (8):719-721.

DOI: 10.5005/jp-journals-10071-23524

License: CC BY-NC 4.0

Published Online: 21-09-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Nicotine is one of the most easily accessible, commonly abused drugs worldwide and if taken in overdose can cause serious clinical presentation, including cardiac arrhythmias and neurotoxicity mediated through oxidative stress. Its toxicity though rare can cause sudden deaths by cardiovascular arrest, respiratory muscle paralysis, and/or central respiratory failure. Here, we describe a case of intentional fatal ingestion of nicotine sulfate decoction used as a mean for fatal suicidal attempt by a 15-year-old adolescent male who was suffering from childhood-onset depression since about 3 months. He developed drooling of saliva, syncopal attacks, paroxysmal episodes of hematemesis, abdominal pain, signs and symptoms of hypoxia, nonfatal atrial tachycardia, and encephalopathy after ingestion of heavy dose of nicotine-containing concoction; however, he recovered successfully within 24–48 hours without any significant cardiac, respiratory, or neurological deficits (except short-term verbal memory). Authors discussed the details of management and reasons behind the reversible encephalopathy and molecular mechanism of nicotine toxicity.


PDF Share
  1. Stolerman IP, Jarvis MJ. The scientific case that nicotine is addictive. Psychopharmacol 1995;117(1):2–10. DOI: 10.1007/BF02245088.
  2. Greenland S, Satterfield MH, Lanes SF. A meta-analysis to assess the incidence of adverse effects associated with the transdermal nicotinic patch. Drug Safety 1998;18(4):297–308. DOI: 10.2165/00002018-199818040-00005.
  3. Rogers AJ, Denk LD, Wax PM. Catastrophic brain injury after nicotine insecticide ingestion. J Emerg Med 2004;26(2):169–172. DOI: 10.1016/j.jemermed.2003.05.006.
  4. Schneider S, Diederich N, Appenzeller B, Schartz A, Lorang C, Wennig R. Internet suicide guidelines: report of a life-threatening poisoning using tobacco extract. J Emerg Med 2010;38(5):610–613. DOI: 10.1016/j.jemermed.2008.10.023.
  5. Khan S, Blanton MP, Chavez M. Nicotine toxicity in a nursing home resident with dementia secondary to nicotine replacement treatment. Prim Care Companion CNS Disord 2016;18(3):10–13. DOI: 10.4088/PCC.15l01882.
  6. Solarino B, Rosenbaum F, Riesselmann B, Buschmann CT, Tsokos M. Death due to ingestion of nicotine-containing solution: case report and review of the literature. Forensic Sci Int 2010;25(195):19–22. DOI: 10.1016/j.forsciint.2009.11.003.
  7. Lavoie FW, Harris TM. Fatal nicotine ingestion. J Emerg Med 1991;9(3):133–136. DOI: 10.1016/0736-4679(91)90318-A.
  8. Corkery JM, Button J, Vento AE, Schifano F. Two UK suicides using nicotine extracted from tobacco employing instructions available on the internet. Forensic Sci Int 2010;15(3):9–13. DOI: 10.1016/j.forsciint.2010.02.004.
  9. Patty's Industrial Hygeine and Toxicology, In: Clayton DG, Clayton FE, ed. 4th ed., New York: John Wiley & Son's Inc.; 1994. p. 3378.
  10. Okamoto M, Kita T, Okuda H, Tanaka T, Nakashima T. Effects of aging on acute toxicity of nicotine in rats. Pharmacol Toxicol 1994;75(1):1–6. DOI: 10.1111/j.1600-0773.1994.tb00316.x.
  11. Woolf A, Burkhart K, Caraccio T, Litovitz T. Self-poisoning among adults using multiple transdermal nicotine patches. J Toxicol Clin Toxicol 1996;34(6):691–698. DOI: 10.3109/15563659609013830.
  12. Mehta MC, Jain AC, Mehta A, Billie M. Cardiac arrhythmias following intravenous nicotine: experimental study in dogs. J Cardiovasc Pharmacol Ther 1997;2(4):291–298. DOI: 10.1177/1074248497 00200407.
  13. Kovacic P, Cooksy A. Iminium metabolite mechanism for nicotine toxicity and addiction: oxidative stress and electron transfer. Med Hypothesis 2005;64(1):104–111. DOI: 10.1016/j.mehy.2004. 03.048.
  14. Vitaliti G, Pavone P, Marino S, Saporito MA, Corsello G, Falsaperla R. Molecular mechanism involved in pathogenesis of early-onset epileptic encephalopathy. Front Mol Neurosci 2019;15(12):118–123. DOI: 10.3389/fnmol.2019.00118.
  15. Jalan R, Shawcross D, Davies N. The molecular pathogenesis of hepatic encephalopathy. Int J Biochem Cell Biol 2003;35(8):1175–1181. DOI: 10.1016/S1357-2725(02)00396-5.
  16. Kim JW. Liquid nicotine toxicity. Ped Emergency Care 2015;31(7): 517–521. DOI: 10.1097/PEC.0000000000000486.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.