Page 1377 - Cote clinical veterinary advisor dogs and cats 4th

693.e4 Nicotine Toxicosis

• The initial signs of nicotine poisoning may • Antacids are contraindicated because they ○ Low-yield cigarette: 3-8 mg
enhance absorption.
be similar to those of anticholinesterase Enhance excretion: ○ Cigarette butt: 5-7 mg
VetBooks.ir similar to intoxication with depressants (e.g., • Fluid diuresis ○ Nicorette gum: 2 or 4 mg/piece (effectively
○ Snuff: 4.6-32 mg/g moist; 12.4-15.6 mg/g
insecticide poisoning. The latter signs are
dry
• Urine acidification may promote excretion of
ethanol, barbiturates, marijuana).
0.3-0.6 mg at bioavailability of 15%)
Initial Database nicotine, but this should be done only if the ○ Nicotrol nasal spray: 10 mg/mL
acid-base status is monitored. Ammonium
• Serum chemistry profile: electrolyte chloride 50 mg/kg PO q 6h or vitamin C ○ Transdermal patches: 8.3-114 mg/patch
abnormalities, prerenal azotemia (vomiting, 20-30 mg/kg IM or IV q 8h can be used. ○ Nicotine inhaler: 10 mg/cartridge
dehydration) Treat sinus bradycardia with atropine 0.04 mg/ ○ E-cigarettes: cartridges have 6-36 mg of
• Blood gas analysis and arterial blood pressure kg SQ, IM, or IV as needed, and provide sup- nicotine. Refill/recharger bottles contain
if systemic signs portive care as indicated: up to 36 mg nicotine/mL (and may be
• Electrocardiogram (ECG): sinus bradycardia • Oxygen and/or artificial respiration for 10-30 mL bottles).
or sinus tachycardia most common, ventricu- respiratory difficulty or paralysis (pp. 1146
lar arrhythmias possible and 1185) Prevention
• For seizures, diazepam 0.5-2 mg/kg IV in Keep nicotine-containing products out of pets’
Advanced or Confirmatory Testing dogs and 0.5-1 mg/kg in cats, prn reach.
• Nicotine can be detected in urine, blood,
GI contents, and vomitus/lavage washings. Recommended Monitoring Technician Tips
Contact a veterinary diagnostic laboratory Blood pressure, electrocardiogram, acid-base • Ask about the type of tobacco product
or a human hospital for analysis, but status, CNS signs, respiratory rate and effort involved to determine the potential dose
confirmation should not delay initiation of of nicotine.
treatment if nicotine toxicosis is known or PROGNOSIS & OUTCOME • Xylitol is more likely to cause toxicosis than
suspected. nicotine in gums flavored with xylitol.
• Necropsy samples: nicotine in liver and • Prognosis good if only GI signs seen
kidney • Poor prognosis if CNS and cardiovascular SUGGESTED READING
depressive signs occur or if artificial ventila- Plumlee KH: Nicotine. In Peterson ME, et al, editors:
TREATMENT tion is required Small animal toxicology, ed 3, St. Louis, 2013,
Saunders, pp 683-685.
Treatment Overview PEARLS & CONSIDERATIONS
Treatment consists of management of severe ADDITIONAL SUGGESTED
CNS signs first (e.g., seizures) or decontamina- Comments READINGS
tion of the patient (induce vomiting and give • In dogs, plant material (cigarettes, cigars) Cheeke PR: Tobacco (Nicotiana spp.); natural
activated charcoal) in cases not showing overt rarely causes more than mild vomiting. toxicants in feeds, forages, and poisonous plants,
clinical signs and enhancement of excretion of • Most dogs vomit spontaneously after inges- Danvile, IL, 1998, Interstate Publishers, pp
nicotine in all likely or confirmed cases. tion, reducing the severity of toxicosis. 383-385.
• Some nicotine gums and mints contain Hackendahl NC: The dangers of nicotine ingestion
Acute General Treatment significant amounts of xylitol (p. 1050). in dogs. Vet Med 99:218-224, 2004.
Decontamination of patient (p. 1087): • Nicotine is absorbed more in alkaline pH.
• Decontamination of dermal exposure: bathe In humans, the half-life is 2 hours; excretion RELATED CLIENT EDUCATION
the patient with liquid hand dishwashing occurs through kidneys and is pH dependent. SHEET
detergent (wear thick rubber gloves). • Nicotine from gum has comparatively low
• Induction of emesis < 1 hour after exposure bioavailability (≈15%). How to Induce Vomiting
in asymptomatic patients, longer with • The LD50 for nicotine in dogs is 9.2 mg/
cigarettes or other plant material (p. 1188) kg. AUTHOR: Charlotte Means, DVM, MLIS, DABVT, DABT
• Activated charcoal 1-2 g/kg PO, one dose; • Nicotine content in various products EDITOR: Tina Wismer, DVM, MS, DABVT, DABT
most ingestions do not require activated ○ Cigar: 15-40 mg/cigar
charcoal ○ Cigarettes: 13-30 mg/cigarette

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