Nicotine toxicity

Background

Nicotine is an alkaloid. Alkaloids are a group of compounds that are typically produced by plants to discourage animals from eating them.
Nicotine commonly comes from the tobacco plant
There are 66 other plants from which nicotine can be obtained.
These plants are apart of the nightshade family (include eggplant, tomato, potato, green pepper)
Free-base nicotine is used as an insecticide since it is highly poisonous and reactive with oxygen and other chemicals, destroying cells and tissues.

There are 2 types of neuronal nicotinic receptors, cns and pns (alpha-bungarotoxin). These are ligand gated ion channels.
Nicotine binds to these receptors that are located on nerve terminals or on axons on cell bodies, alpha-bungarotoxin, polypeptide that binds irreversibly to nicotinic receptors with a high binding affinity
Nicotinic acetylcholine receptors are made up of alpha and beta subunits that form a pentameric motif
Different combinations of these subunits have different effects in the body.
Interferes with the binding of acetylcholine, binds to the receptor which then opens the ion channel releasing sodium into the cell.
Nicotine’s most important effect is the activation of the reward pathway which is caused by dopamine release.

If there are are also muscarinic effects then strongly consider an broader treatment for Cholinergic Syndrome

Depending on severity of symptoms patients can be admitted for continued aggressive supportive care or discharged if symptoms all resolve in the ED

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