Thursday, 2 December 2010

I've not seen it all before

I've worked in general practice for 30 years and frequently seek to reassure patients who are about to show me something that they would rather keep hidden that, "I've seen it all before".  I realised this week that that is far from the truth as I was consulted by a young mother who was concerned about her 13 month old who had managed to eat half of a cigarette. My instinct was to immediately reassure her, but upon reflection, reading and consulting the national poisons line, I changed my tune.

Nicotine in tobacco is a toxic alkaloid called solanine (the same toxin as occurs in deadly nightshade and the green of potatoes exposed to the sun). Ingesting nicotine chemical results in a build up of the  neurotransmitter called acetylcholine. At lowish doses it causes nausea, vomiting and palpitations and at higher dosages may cause delirium, paralysis and death! Apparently ingesting 5 cigarettes or half a cigar is enough to kill an adult!

Fortunately my patient recovered apart from a few hours of vomiting. I've lots to learn yet.
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