Nicotine is a common stimulant drug found worldwide in many cultures, and is often consumed for it’s stimulatory effects. Nicotine usage has been common throughout different cultures, manifesting itself in the chewing of certain plant material or smoking compounds that contain nicotine. This drug is one of the most commonly used worldwide following alcohol, and presents a clear epidemiological concern in the present day with the rise of alternative nicotine sources besides cigarettes, such as electronic-cigarettes and hookah pipes. Nicotine has potent addictive qualities at continued low doses over time, as it stimulates the “reward center” of the brain. (Robison 2011).
Nicotine predominantly is extracted from the leaves of the Nightshade family of flowering plants, including tobacco, where it naturally exists as an alkaloid byproduct. Nicotine’s mechanism of action allows for it to work at the same locations within the nervous system that are responsible for controlling muscle movement, and in fact preferentially binds to the sites within the nervous system that are responsible for this behavior. In nature, nicotine is primarily used by plants as a pesticide, as low concentrations are enough to dissuade or kill potential herbivores.
Although nicotine in the concentrations found within cigarettes is of little acute danger to the smoker (Armitage 1975), the mechanisms by which nicotine can enter the body are more diverse. Nicotine is capable of being absorbed through the skin and mucous membranes such as the mouth, and it is much easier to have acute effects due to high concentrations of nicotine absorbed in these situations. This is specifically an issue in the case of teething children , who are both more likely to accidentally come into contact with and consume nicotine products, as well as being less resistant to the acute effects due to smaller size. With the LD50 of nicotine found to be between .5 and 1.0 grams nicotine per kilogram of body weight, a curious infant will have a much more intense response to consuming a discarded cigarette than an adult smoke might have from smoking several cigarettes themselves. Alternative accidental sources of nicotine overdoses include all forms of tobacco, with special mention being made of chewing tobacco, pipe tobacco, and specific nicotine delivery systems including liquid nicotine refill capsules for electronic cigarettes and nicotine gum.
Liquid nicotine refill capsules present another threat, as they tend to contain higher concentrations of nicotine then alternate sources, and may be absorbed through skin and mucous membranes easily, leading to accidental poisonings.
In years past when the primary commercial form of nicotine was within cigarettes, the cases of accidental ingestion and subsequent acute toxicity were rather low, occurring predominantly with mobile infants of less than 6 years of age eating cigarettes, with teething infants between 6 and 36 months being at greatest risk. With the rise of electronic cigarettes, and the liquid nicotine capsules therein, the chance of accidental contact and acute toxicity increases. CDC notes from the field indicate a rise in percentage of nicotine-toxicity related incidents arising from electronic cigarettes as compared to traditional cigarettes.(Chatham-Stevens 2014) Additionally, while the knowledge of tobacco’s harmful effects is known in the public consciousness, the danger of acute nicotine exposure is significantly less popularly understood. With it’s profound effects on connections within the brain and control of muscles, nicotine can be recognized as less benign then some might think when compared to other drugs.