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Message: <blockquote data-quote="alsih2o" data-source="post: 405729" data-attributes="member: 4790">from here- <a href="http://www.medal.org/docs_ch33/doc_ch33.21.html#A33.21.1" target="_blank">http://www.medal.org/docs_ch33/doc_ch33.21.html#A33.21.1</a> we have a document on when to hospitalize those suffering from nicotine ingestion and (part 2)a handy guide to figuring out how long smoking will take to kill you via statistical somethingorrathers. <img src="https://cdn.jsdelivr.net/joypixels/assets/8.0/png/unicode/64/1f642.png" class="smilie smilie--emoji" loading="lazy" width="64" height="64" alt=":)" title="Smile    :)"  data-smilie="1"data-shortname=":)" />>>>33.21 Nicotine Toxicity and Tobacco UseTable of Contents, Chap. 33 >>>33.21.01 Criteria for Hospital Admission After Acute Nicotine IngestionOverview:Nicotine is toxic and can be lethal. Patients who have signficant exposure to nicotine especially through ingestion should be hospitalized. Symptoms and Signs of Acute Overdosage• nausea vomiting hiccups dry mouth dyspepsia diarrhea lacrimation salivation• cyanosis hyperventilation apnea increased bronchial secretions respiratory depression• insomnia headache ataxia dementia mental confusion lightheadedness seizures• hyponatremia hyperglycemia methemoglobinuria• blurred vision nystagmus mydriasis ototoxicity tinnitus dysosmia (defect in smell)• myalgia abdominal pain myoclonus muscle fasciculations/paralysis paresthesias myasthenia hypotonia hyperreflexia agitation• hyperthermia• AV block tachycardia hypertension bradycardia (later) hypotension (later) atrial fibrillation cardiac arrestCriteria for hospital admission:(1) pediatric ingestion• > 2 whole cigarettes• > 6 cigarette butts• > 10 pieces of nicotine gum• a whole cigar or more• mouthful of chewing tobacco• nicotine patch• nicotine-containing insecticides• >= 40 mg nicotine total(2) patients with tachycardia or hypertension more than 4 hours after exposure(3) change in mental status seizure activity(4) cardiopulmonary complaints (cyanosis respiratory depression apnea AV block severe hypertension or hypotension etc.)(5) methemoglobin levels > 30%Patients with methemoglobin levels < 30% may be discharged after 6 hours of observation if methemoglobin levels are < 15%.Management of an acute overdosage(1) the airway should be maintained with supplemental oxygen as needed(2) empty gastric contents and administer activate charcoal(3) provide cardiac monitoring in moderate to severe cases(4) wash exposed skin(5) atropine can help control excessive bronchial secretions salivation or diarrhea(6) seizures may be controlled with barbiturates or diazepam(7) mechanical ventilation may be required for severe respiratory depressionPrognostic features(1) Survival after 4 hours is usually associated with complete recovery.(2) The absence of vomiting predicts a favorable outcome.References:Ellenhorn MJ. Ellenhorn's Medical Toxicology: Diagnosis and Treatment of Human Poisoning Second Edition. Williams & Wilkins. 1997. pages 1114-1118.Leikin JB Paloucek FP. Poisoning & Toxicity Compendium. Lexi-Comp Inc. 1998. page 412.Table of Contents, Chap. 33 >>>33.21.02 Equation of Doll and Peto for Predicting Annual Lung Cancer Incidence in Cigarette SmokersOverview:Doll and Peto studied a group of British physicians who smoked and derived equations to predict the annual lung cancer incidence in the population as it aged. The study was done at the Radcliffe Infirmary at the University of Oxford in England.Factors affecting incidence of lung cancer in cigarette smokers include:(1) duration of smoking(2) quantity of cigarettes smoked daily(3) silica uranium asbestos and other inhaled dusts associated with pneumoconiosis(4) radon and other radiation sources(5) bronchitis and other chronic lung infectionsIn general the cancer risk depends more on the duration of smoking than the daily dose-rate of cigarette smoking . ("Smoking 2 packs/day for 20 years is far less hazardous than smoking one pack/day for 40 years." Finkelstein 1998 page 248). Giving up smoking in later adult life is associated with a substantial decrease on risk 5-10 years later (Doll 1978 page 303).Patient criteria for equation of Doll and Peto:(1) Patient who started smoking from between ages 16 and 25(2) Patient smoked 1-40 cigarettes per day.annual lung cancer incidence for ages 40-79 == 0.273 * 10^(-12) * (((cigarettes smoked per day) + 6)^2) * (((age in years) – 22.5)^4.5)where:• 0.273 * 10^(-12) is the incidence proportion• (((cigarettes) + 6)^2) is the dose• 4.5 as the age exponentAlternative equations for different data approximations:Model Incidence Proportion Dose Age Exponent curved 1.74 * 10^(-12) (((daily cigarettes) + 6)^2) 4 curved 0.0423 * 10^(-12) (((daily cigarettes) + 6)^2) 5 linear 60.4 * 10^(-12) ((daily cigarettes) + 1) 4 linear 9.46 * 10^(-12) ((daily cigarettes) + 1) 4.5 linear 1.46 * 10^(-12) ((daily cigarettes) + 1) 5 References:Doll R Peto R. Cigarette smoking and bronchial carcinoma: Dose and time relationships among regular smokers and lifelong non-smokers. J Epidemiol Community Health. 1978; 32: 303-313.Finkelstein MM. Radiographic silicosis and lung cancer risk among workers in Ontario. Am J Indust Med. 1998; 34: 244-251.Peto R. Influence of dose and duration of smoking on lung cancer rates. pages 23-33. IN: Zaridze DG Peto R (editors). Tobacco: A Major International Health Hazard. International Agency for Research on Cancer World Health Organization. Lyon. 1986Table of Contents, Chap. 33</blockquote>

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