Fatal nicotine ingestion

Nicotine is one of the most readily available and commonly abused drugs in modern society. However, serious or fatal overdoses of this agent are rare. We present a case of intentional fatal ingestion of nicotine alkaloid solution. This diagnosis may be elusive since nicotine is commonly qualitatively identified on urine toxicology screens, but is seldom quantified. Clinicians should be knowledgeable about the nature of this agent and its pathophysiologic presentations since recognition of the toxidrome is often necessary to make this diagnosis.