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Death related to nicotine replacement therapy: A case report
J-A Tjoncke1, R Goncalves2, N Castaing2
1Institut de Médecine Légale, CHU De Bordeaux, Place Amélie Raba Leon, 33076 Bordeaux Cedex, France.
Forensic Science International
|March 9, 2020
Summary
This case report details a fatal nicotine poisoning from excessive use of nicotine replacement therapy patches and tablets. It highlights the critical need for comprehensive toxicological analysis in suspected overdose cases.
Area of Science:
- Forensic Toxicology
- Clinical Pharmacology
Background:
- Nicotine replacement therapy (NRT) products like patches and tablets are common smoking cessation aids.
- Fatal nicotine poisoning from NRT misuse is rare but possible, necessitating awareness.
Observation:
- A 41-year-old male was found deceased with multiple nicotine patches applied and empty nicotine tablet packaging nearby.
- Autopsy revealed signs of asphyxia, with toxicological analysis showing lethal levels of nicotine and its metabolite, cotinine, in blood.
Findings:
- Lethal concentrations of nicotine (femoral: 2239 ng/mL, cardiac: 1344 ng/mL) and cotinine (femoral: 1230 ng/mL, cardiac: 1090 ng/mL) were detected.
- Other substances including cyamemazine, benzodiazepines, and cannabis metabolites were present at therapeutic or indicative levels.
Implications:
- This case underscores the potential for severe nicotine toxicity, even fatal, from NRT misuse.
- Complete toxicological screening is crucial to accurately diagnose nicotine poisoning and prevent similar fatalities from being missed.
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