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A case of life-threatening rectal administration of moist snuff.

Journal article
Authors Kai Knudsen
Morten Strinnholm
Published in Clinical toxicology (Philadelphia, Pa.)
Volume 48
Issue 6
Pages 572-3
ISSN 1556-9519
Publication year 2010
Published at Institute of Clinical Sciences, Department of Anesthesiology and Intensive care
Pages 572-3
Language en
Links dx.doi.org/10.3109/15563650.2010.49...
Keywords Administration, Rectal, Adult, Humans, Male, Nicotine, poisoning, Tobacco, Smokeless, poisoning
Subject categories Biological research on drug dependence

Abstract

CASE REPORT: We report a case of self-administration of 75 sachets of moist snuff rectally in a previously healthy, 42-year-old man. He presented with symptoms of nausea, discomfort, and dizziness. He had dry and warm skin, a pulse rate of 53 bpm, a mean arterial blood pressure of 135 mmHg and fluctuations in consciousness. The patient was treated with mechanical ventilation because of respiratory insufficiency. No specific anti-nicotinergic treatment was given. Plasma levels of the nicotine metabolite cotinine were 8,691 μg/L 7 h after admittance and 9,814 μg/L after 12 h. Levels of cotinine in the urine were above >50,000 μg/L. The patient developed a mild pneumonia, but he was uneventfully extubated after 12 h of mechanical ventilation. All physiological parameters were restored and he was discharged from hospital after 36 h. CONCLUSION: Excessive rectal administration of moist snuff may be life threatening. Patients may require intensive care. Long-term sequelae were not seen in this case.

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