@article{ref1,
title="Internet suicide guidelines: Report of a life-threatening poisoning using tobacco extract",
journal="Journal of emergency medicine",
year="2010",
author="Schneider, Silvia and Diederich, Nico and Appenzeller, Brice and Schartz, Anne and Lorang, Christiane and Wennig, Robert",
volume="38",
number="5",
pages="610-613",
abstract="Background: Severe nicotine intoxication occurred in a patient after ingestion of a tobacco extract made from a recipe found on a freely available Internet site. Objectives: To determine the levels of nicotine and cotinine in the plasma of a patient who tried to commit suicide by drinking a highly concentrated tobacco extract. Case report: A 67-year-old man tried to commit suicide by following guidelines found on an Internet site. He soaked 300 grams of tobacco for 3 days in water, evaporated most of the extract, and drank the rest of it. He felt sick immediately, with the following signs: respiratory depression, hypothermia, hypersalivation, bradycardia, and myoclonic jerks. Soon after the ingestion he vomited most of the extract. Toxicological analysis revealed potentially life-threatening nicotine and cotinine serum concentrations. Surprisingly, nicotine peak levels (322 mug/L) and cotinine peak levels (9092 mug/L) were reached more than 3 h after ingestion of the extract. Estimated nicotine and cotinine half-lives were 200 min and 1185 min, respectively. Treatment consisted of gastric lavage, ventilation, and monitoring of vital functions. The patient recovered and was discharged from the Emergency Department 4 days later without sequelae. Conclusion: Nicotinergic intoxication is not always easy to recognize, and without clues from the patient and the toxicologic analysis, might well have been missed in the present case.<p /> <p>Language: en</p>",
language="en",
issn="0736-4679",
doi="10.1016/j.jemermed.2008.10.023",
url="http://dx.doi.org/10.1016/j.jemermed.2008.10.023"
}