How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century

Mayer, Bernd

doi:10.1007/s00204-013-1127-0

Cited by 219 publications

(150 citation statements)

References 14 publications

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“…But newly developed refillable e-cigarettes comprise 10 ml or even more that may contain 200-300 mg of purest nicotine. The lethal dose of nicotine was recently discussed in this journal (Mayer 2014). Although we can accept the arguments for adjusting the estimates, a possible content of 200-300 mg nicotine in a single product remains unacceptable for such consumer products that are unrestrictedly sold over the counter.…”

mentioning

confidence: 97%

“…limits to exempt products from authorization were set to 2 mg nicotine per unit or 4 mg nicotine/ml liquid. In light this perspective, the recent statement of Mayer (2014) that "concerns about ingestion of small amounts of tobacco products or diluted nicotine-containing solutions are unjustified" becomes comprehensible. But was this initial proposal really overcautious?…”

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confidence: 99%

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E-cigarettes in Europe: does regulation swing from overcautious to careless?

Henkler

Luch

2014

Arch Toxicol

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confidence: 97%

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confidence: 99%

E-cigarettes in Europe: does regulation swing from overcautious to careless?

Henkler

Luch

2014

Arch Toxicol

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“…After several detailed reviews, Mayer has argued that a careful estimate suggests that a lower limit causing fatal outcomes is 0.5 to 1 g/kg of ingested nicotine, corresponding to an LD50 of 6.5 to 13 mg/kg. 7 In the case we report, if our patient ingested the entire bottle of liquid nicotine, she would have consumed approximately 1.4 grams of nicotine, or 107 mg/kg, an amount over 50 times the dose reported to result in severe toxicity.…”

Section: Discussionmentioning

confidence: 70%

E-Cigarette Liquid Nicotine Ingestion in a Child: Case Report and Discussion

Gill

Sangha

Poonai

et al. 2015

CJEM

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Nicotine poisoning is well described in the pediatric population, and even small oral doses may result in toxic effects. The source of nicotine is usually tobacco products and nicotine replacement products such as gum and patches. With the more frequent use of novel products such as e-cigarettes, concern has arisen regarding liquid nicotine. As there are no regulations regarding childproof bottling and packaging, there may be increased potential for unintentional ingestion of these colorfully and appealingly packaged products by children. We present and discuss a case of this nature, as we feel emergency physicians should be aware of this new mode of poisoning, and public health efforts should be made to minimize such exposures. RÉSUMÉL'intoxication à la nicotine est bien connue chez les enfants, et même de faibles doses orales peuvent produire des effets toxiques. Les sources habituelles de nicotine sont les produits du tabac et les produits de remplacement de la nicotine comme les gommes à mâcher et les timbres. Toutefois, l'utilisation de plus en plus grande de nouveaux produits tels que la cigarette électronique soulève des craintes en ce qui concerne la nicotine liquide. Comme ces articles ne font l'objet d'aucune réglementation au regard de l'emballage et de la mise en bouteilles à l'épreuve des enfants, il existe un risque accru d'ingestion accidentelle, par les enfants, de cette substance à utiliser dans des produits attrayants et aux couleurs vives. À preuve le cas ici exposé, suivi d'une discussion; les auteurs sont d'avis que les médecins d'urgence devraient être sensibilisés à cette nouvelle forme d'intoxication, et les autorités en matière de santé publique devraient tâcher de réduire ces risques au minimum.

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“…Mayer recently showed that the traditionally proposed nicotine lethal dose of 30 to 60 mg came from dubious experiments performed more than 150 years ago. 8 By evaluating postmortem examinations, he defined that the lethal dose would be 500 to 1,000 mg of acute intake, almost 20 times higher than currently assumed. In fact, this represents the total amount of nicotine that should be absorbed; knowing that voluminous vomiting is the first and main symptom of nicotine intoxication, it seems obvious that you need to ingest even higher amounts of nicotine to absorb lethal quantities.…”

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confidence: 99%

Comment on E-Cigarettes and Cardiovascular Risk: Beyond Science and Mysticism

Farsalinos¹,

Romagna²,

Houezec

2014

Semin Thromb Hemost

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We read with particular interest the short review and opinion by Lippi et al about the potential cardiovascular risk of using e-cigarettes. 1 It is our opinion that certain aspects presented in the article should be further addressed and clarified.The potential risk for cardiovascular disease from e-cigarette use was mainly attributed by the authors to the effects of nicotine. However, several studies have shown that nicotine intake does not elevate cardiovascular risk. Longterm inhalation of nicotine was studied in animals; researchers did not observe any adverse effects on the lungs or development of atherosclerosis. 2 A recent meta-analysis of controlled smoking cessation trials found that, although nicotine replacement therapies (NRTs) had a higher rate of any cardiovascular events, this was driven only by minor events such as heart palpitations; no elevation in the incidence of major adverse cardiovascular events (MACE) was found. 3 Use of NRTs in high-risk individuals was similarly not associated with an elevated risk for MACE. 3 A populationbased case-controlled study among 68 hospitals in the US found that the use of nicotine patches did not elevate the risk of first myocardial infarction. 4 A meta-analysis of 34 randomized controlled trials showed that NRTs did not pose any elevated risk for myocardial infarction, stroke, palpitations, angina, arrhythmia, or hypertension compared with placebotreated patients. 5 Even in patients with established cardiovascular disease, use of NRTs did not confer any additional risk compared with placebo and in fact their use was associated with reduced ischemia-related perfusion defects and elevated time to exercise-induced ischemia. 6 Currently, there is consensus that nicotine has minimal effects in initiating and propagating atherosclerosis. 7 Moreover, Lippi et al seem to have exaggerated on the toxicity of liquid nicotine present in e-cigarettes. Mayer recently showed that the traditionally proposed nicotine lethal dose of 30 to 60 mg came from dubious experiments performed more than 150 years ago. 8By evaluating postmortem examinations, he defined that the lethal dose would be 500 to 1,000 mg of acute intake, almost 20 times higher than currently assumed. In fact, this represents the total amount of nicotine that should be absorbed; knowing that voluminous vomiting is the first and main symptom of nicotine intoxication, it seems obvious that you need to ingest even higher amounts of nicotine to absorb lethal quantities. Further support for this came from a recent presentation of three cases of attempted suicide by ingesting nicotine liquid used for e-cigarettes; none of the cases were fatal, with one of them ingesting 1,500 mg of nicotine. 9 Smokeless tobacco is an alternative form of nicotine intake which does not involve combustion. Still it contains tobacco and several contaminants present in it. Snus is considered the least harmful type of smokeless tobacco due to the manufacturing process and selection of tobacco. A meta-analysis of epidemiological studies hav...

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How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century

Cited by 219 publications

References 14 publications

E-cigarettes in Europe: does regulation swing from overcautious to careless?

E-cigarettes in Europe: does regulation swing from overcautious to careless?

E-Cigarette Liquid Nicotine Ingestion in a Child: Case Report and Discussion

Comment on E-Cigarettes and Cardiovascular Risk: Beyond Science and Mysticism

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