<P> It is unlikely that a person would overdose on nicotine through smoking alone . The US Food and Drug Administration (FDA) stated in 2013: "There are no significant safety concerns associated with using more than one OTC NRT at the same time, or using an OTC NRT at the same time as another nicotine - containing product--including a cigarette ." Ingestion of nicotine pharmaceuticals, tobacco products, or nicotine containing plants may also lead to poisoning . Smoking excessive amounts of tobacco has also led to poisoning; a case was reported where two brothers smoked 17 and 18 pipes of tobacco in succession and were both fatally poisoned . Spilling an extremely high concentration of nicotine onto the skin can result in intoxication or even death since nicotine readily passes into the bloodstream following skin contact . </P> <P> The recent rise in the use of electronic cigarettes, many forms of which are designed to be refilled with nicotine - containing "e-liquid" supplied in small plastic bottles, has renewed interest in nicotine overdoses, especially in the possibility of young children ingesting the liquids . A 2015 report on e-cigarettes by Public Health England noted an "unconfirmed newspaper report of a fatal poisoning of a two - year old child" and two published case reports of children of similar age who had recovered after ingesting e-liquid and vomiting . They also noted case reports of suicides by nicotine . Where adults drank liquid containing up to 1,500 mg of nicotine they recovered (helped by vomiting), but an ingestion apparently of about 10,000 mg was fatal, as was an injection . They commented that "Serious nicotine poisoning seems normally prevented by the fact that relatively low doses of nicotine cause nausea and vomiting, which stops users from further intake ." Four adults died in the US and Europe, after intentionally ingesting liquid . Two children, one in the US in 2014 and another in Israel in 2013, died after ingesting liquid nicotine . </P> <P> Nicotine poisoning tends to produce symptoms that follow a biphasic pattern . The initial symptoms are mainly due to stimulatory effects and include nausea and vomiting, excessive salivation, abdominal pain, pallor, sweating, hypertension, tachycardia, ataxia, tremor, headache, dizziness, muscle fasciculations, and seizures . After the initial stimulatory phase, a later period of depressor effects can occur and may include symptoms of hypotension and bradycardia, central nervous system depression, coma, muscular weakness and / or paralysis, with difficulty breathing or respiratory failure . </P> <P> From September 1, 2010 to December 31, 2014, there were at least 21,106 traditional cigarette calls to US poison control centers . During the same period, the ten most frequent adverse effects to traditional cigarettes reported to US poison control centers were vomiting (80.0%), nausea (9.2%), drowsiness (7.8%), cough (7.2%), agitation (6.6%), pallor (3.0%), tachycardia (2.5%), diaphoresis (1.5%), dizziness (1.5%), and diarrhea (1.4%). 95% of traditional cigarette calls were related to children 5 years old or less . Most of the traditional cigarette calls were a minor effect . </P>

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