Internet suicide guidelines: report of a life-threatening poisoning using tobacco extract

J Emerg Med. 2010 Jun;38(5):610-3. doi: 10.1016/j.jemermed.2008.10.023. Epub 2009 Mar 9.


Background: Severe nicotine intoxication occurred in a patient after ingestion of a tobacco extract made from a recipe found on a freely available Internet site.

Objectives: To determine the levels of nicotine and cotinine in the plasma of a patient who tried to commit suicide by drinking a highly concentrated tobacco extract.

Case report: A 67-year-old man tried to commit suicide by following guidelines found on an Internet site. He soaked 300 grams of tobacco for 3 days in water, evaporated most of the extract, and drank the rest of it. He felt sick immediately, with the following signs: respiratory depression, hypothermia, hypersalivation, bradycardia, and myoclonic jerks. Soon after the ingestion he vomited most of the extract. Toxicological analysis revealed potentially life-threatening nicotine and cotinine serum concentrations. Surprisingly, nicotine peak levels (322 microg/L) and cotinine peak levels (9092 microg/L) were reached more than 3 h after ingestion of the extract. Estimated nicotine and cotinine half-lives were 200 min and 1185 min, respectively. Treatment consisted of gastric lavage, ventilation, and monitoring of vital functions. The patient recovered and was discharged from the Emergency Department 4 days later without sequelae.

Conclusion: Nicotinergic intoxication is not always easy to recognize, and without clues from the patient and the toxicologic analysis, might well have been missed in the present case.

Publication types

  • Case Reports

MeSH terms

  • Administration, Oral
  • Aged
  • Depressive Disorder*
  • Humans
  • Internet
  • Male
  • Nicotine / administration & dosage
  • Nicotine / poisoning*
  • Plant Extracts / administration & dosage
  • Plant Extracts / poisoning*
  • Suicide, Attempted*
  • Tobacco / poisoning*


  • Plant Extracts
  • Nicotine