Editing Nicotine (section)

==Overdose==
{{Main|Nicotine poisoning}}

It is unlikely that a person would overdose on nicotine through smoking alone. The US [[Food and Drug Administration]] (FDA) stated in 2013 that there are no significant safety concerns associated with the use of more than one form of [[Over-the-counter drug|over-the-counter]] (OTC) [[nicotine replacement therapy]] at the same time, or using OTC NRT at the same time as another nicotine-containing product, like cigarettes.<ref name=FDANRTLabels>{{cite web|title=Consumer Updates: Nicotine Replacement Therapy Labels May Change|url=https://www.fda.gov/forconsumers/consumerupdates/ucm345087.htm|publisher=FDA|date=1 April 2013}}</ref> The [[median lethal dose]] of nicotine in humans is unknown.<ref name="ECHA nicotine monograph">{{cite web |title=Nicotine |url=https://echa.europa.eu/documents/10162/31694def-b7c3-208d-5aaf-3db9681ec3b9 |publisher=European Chemicals Agency: Committee for Risk Assessment |access-date=23 January 2019|date=September 2015}}</ref><ref name=MayerNewLethalDose2013>{{cite journal | vauthors = Mayer B | title = How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century | journal = Archives of Toxicology | volume = 88 | issue = 1 | pages = 5–7 | date = January 2014 | pmid = 24091634 | pmc = 3880486 | doi = 10.1007/s00204-013-1127-0 | bibcode = 2014ArTox..88....5M }}</ref> Nevertheless, nicotine has a relatively high [[toxicity]] in comparison to many other alkaloids such as [[caffeine]], which has an LD<sub>50</sub> of 127&nbsp;mg/kg when administered to mice.<ref>''[[Toxicology and Applied Pharmacology]].'' Vol. 44, Pg. 1, 1978.</ref> At sufficiently high doses, it is associated with nicotine poisoning,<ref name=SGUS2014/> which, while common in children (in whom poisonous and lethal levels occur at lower doses per kilogram of body weight<ref name=Schraufnagel2015/>) rarely results in significant morbidity or death.<ref name="TOXNET Nicotine entry" /> The estimated lower dose limit for fatal outcomes is 500–1,000&nbsp;mg of ingested nicotine for an adult (6.5–13&nbsp;mg/kg).<ref name="RCP"/><ref name=MayerNewLethalDose2013/>

The initial symptoms of a nicotine overdose typically include [[nausea]], vomiting, diarrhea, [[hypersalivation]], abdominal pain, [[tachycardia]] (rapid heart rate), [[hypertension]] (high blood pressure), [[tachypnea]] (rapid breathing), headache, dizziness, [[pallor]] (pale skin), auditory or visual disturbances, and perspiration, followed shortly after by marked [[bradycardia]] (slow heart rate), [[bradypnea]] (slow breathing), and [[hypotension]] (low blood pressure).<ref name="TOXNET Nicotine entry" /> An increased respiratory rate (i.e., [[tachypnea]]) is one of the primary [[medical sign|signs]] of nicotine poisoning.<ref name="TOXNET Nicotine entry" /> At sufficiently high doses, [[somnolence]] (sleepiness or drowsiness), [[confusion]], [[syncope (medicine)|syncope]] (loss of consciousness from fainting), [[shortness of breath]], marked [[weakness]], [[seizure]]s, and [[coma]] may occur.<ref name="inchem" /><ref name="TOXNET Nicotine entry" /> Lethal nicotine poisoning rapidly produces seizures, and death&nbsp;– which may occur within minutes&nbsp;– is believed to be due to [[respiratory paralysis]].<ref name="TOXNET Nicotine entry" />

===Toxicity===
Today nicotine is less commonly used in agricultural [[insecticide]]s, which was a main source of poisoning. More recent cases of poisoning typically appear to be in the form of [[Green Tobacco Sickness]] (GTS),<ref name="TOXNET Nicotine entry" /> accidental ingestion of [[tobacco]] or [[tobacco products]], or ingestion of nicotine-containing plants.<ref name="Schep"/><ref name="Smolinske">{{cite journal | vauthors = Smolinske SC, Spoerke DG, Spiller SK, Wruk KM, Kulig K, Rumack BH | title = Cigarette and nicotine chewing gum toxicity in children | journal = Human Toxicology | volume = 7 | issue = 1 | pages = 27–31 | date = January 1988 | pmid = 3346035 | doi = 10.1177/096032718800700105 | s2cid = 27707333 }}</ref><ref name="Furer">{{cite journal | vauthors = Furer V, Hersch M, Silvetzki N, Breuer GS, Zevin S | title = Nicotiana glauca (tree tobacco) intoxication--two cases in one family | journal = Journal of Medical Toxicology | volume = 7 | issue = 1 | pages = 47–51 | date = March 2011 | pmid = 20652661 | pmc = 3614112 | doi = 10.1007/s13181-010-0102-x }}</ref> People who harvest or cultivate tobacco may experience GTS, a type of nicotine poisoning caused by dermal exposure to wet tobacco leaves. This occurs most commonly in young, inexperienced tobacco harvesters who do not consume tobacco.<ref name=Schep>{{cite journal | vauthors = Schep LJ, Slaughter RJ, Beasley DM | title = Nicotinic plant poisoning | journal = Clinical Toxicology | volume = 47 | issue = 8 | pages = 771–81 | date = September 2009 | pmid = 19778187 | doi = 10.1080/15563650903252186 | s2cid = 28312730 }}</ref><ref>{{cite journal | vauthors = Gehlbach SH, Williams WA, Perry LD, Woodall JS | title = Green-tobacco sickness. An illness of tobacco harvesters | journal = JAMA | volume = 229 | issue = 14 | pages = 1880–3 | date = September 1974 | pmid = 4479133 | doi = 10.1001/jama.1974.03230520022024 }}</ref> People can be exposed to nicotine in the workplace by breathing it in, skin absorption, swallowing it, or eye contact. The [[Occupational Safety and Health Administration]] (OSHA) has set the legal limit ([[permissible exposure limit]]) for nicotine exposure in the workplace as 0.5&nbsp;mg/m<sup>3</sup> skin exposure over an 8-hour workday. The US [[National Institute for Occupational Safety and Health]] (NIOSH) has set a [[recommended exposure limit]] (REL) of 0.5&nbsp;mg/m<sup>3</sup> skin exposure over an 8-hour workday. At environmental levels of 5&nbsp;mg/m<sup>3</sup>, nicotine is [[IDLH|immediately dangerous to life and health]].<ref>{{cite web|title=CDC – NIOSH Pocket Guide to Chemical Hazards – Nicotine|url =https://www.cdc.gov/niosh/npg/npgd0446.html|website=www.cdc.gov|access-date=20 November 2015}}</ref>
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