Korean J Leg Med.  2018 May;42(2):71-75. 10.7580/kjlm.2018.42.2.71.

Various Forms of Fatal Nicotine Intoxications: Three Cases Report

Affiliations
  • 1Department of Pathology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 2Division of Forensic Medicine, National Forensic Service Daejeon Institute, Daejeon, Korea.
  • 3Division of Forensic Investigation, National Forensic Service Seoul Institute, Seoul, Korea. sanchee@korea.kr

Abstract

Recently, fatal nicotine intoxications with electronic cigarette liquid have increased in Korea, but various kinds of cigarettes and smoking cessation aids may also cause fatal poisoning. We report cases of fatal nicotine intoxications involving causes other than the use of liquid nicotine. A 29-year-old woman (case 1) found dead in a hotel room with about 70 patches (21 mg dose) of nicotine on her body. Blood nicotine levels were 7.68 mg/L (heart) and 3.25 mg/L (femoral). A toxic level of zolpidem was also detected. A 28-year-old Uzbekistan man (case 2) was found dead in his uncle's room with his face covered with chewing tobacco. Blood nicotine levels were 7.3 mg/L (heart) and 4.6 mg/L (femoral). Blood alcohol level was 0.139%. A 55-year-old man (case 3) bit his tongue. As he was taken to the hospital, his wife put tobacco powders in his mouth for hemostasis, and he died of cardiac arrest. Blood nicotine levels were 2.01 mg/L (heart) and 0.96 mg/L (femoral). Nicotine-related deaths can be caused by various types of administration including transdermal and transmucosal routes, and relatively small doses may cause death, so meticulous investigation should be taken when such deaths are suspected.

Keyword

Nicotine; Tobacco use cessation products; Tobacco; Death

MeSH Terms

Adult
Blood Alcohol Content
Electronic Cigarettes
Female
Heart Arrest
Hemostasis
Humans
Korea
Middle Aged
Mouth
Nicotine*
Poisoning
Powders
Smoking Cessation
Spouses
Tobacco
Tobacco Products
Tobacco Use Cessation Products
Tobacco, Smokeless
Tongue
Uzbekistan
Blood Alcohol Content
Nicotine
Powders

Figure

  • Fig. 1 Multiple rectangular or circular intradermal hemorrhages were observed in the neck and chest (A), back (B), and waist (case 1).

  • Fig. 2 Foci of yellowish green discolorations were observed on his head and face (case 2).

  • Fig. 3 There was a sutured laceration to the left of the tongue and a small amount of blood in the oral cavity (case 3).

  • Fig. 4 The stomach contained some black brown foreign material (case 3).


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