I read with interest (as always) Dr. Leon Gussow's column on nicotine toxicity in the March issue (“Nicotine Toxicity Rare in Adults but not Children,” 2006;28:17), and agree with him on the symptoms. Luckily, I have never had them to his extent, despite bringing home and smoking the occasional cigar from a Havana conference.
I have never treated nicotine poisoning, but the article brought to mind another cause of nicotine poisoning that I saw in the low country of North Carolina during my first year as an emergency physician. Back then, and probably still, tobacco was often harvested by hand, using migrant workers and other temporary help. It was not unusual to see moderate symptoms of nicotine poisoning in teenage and adult workers in the field.
These were usually first-time workers, and luckily they recovered with minimal intervention and care. Anecdotally, I never remember treating a smoker for green tobacco syndrome. The more experienced workers always knew to wear long-sleeved shirts, regardless of the heat or humidity, to avoid the sweat-induced transdermal absorption of nicotine from the tobacco leaves as they carried them over their arms during the harvest.
Once we advised the new workers of this ploy, we never saw them in the ED again, unless it was to treat copperhead snake bites from walking in the fields in bare feet.
Congratulations on a well-written and useful magazine.
Donald L. Miller, MD