Acute Nicotine Poisoning From Nicotine Pouch Use in Adolescents: A Case Report of Two Pediatric Cases

Acute nicotine poisoning is a well-studied clinical condition in both adults and children. However, poisoning resulting from the absorption of nicotine through the oral mucosa, as with modern nicotine pouches, is a complex and emerging field of medical research. This process is influenced by various factors that require further investigation, especially in the vulnerable age group of minors under 18 years, for whom the use of these products is legally prohibited. Based on two incidents of acute nicotine poisoning following the use of nicotine pouches in pediatric patients, the clinical and toxicological aspects of such conditions are discussed. The incidents concerned a 15-year-old boy and a 13-year-old girl. Both patients experienced symptoms consistent with nicotine poisoning, such as dizziness, nausea, vomiting, and loss of consciousness, which appeared within 90 and 20 minutes, respectively, after using the products. Both patients improved with supportive care. Samples taken upon their admission for toxicology testing confirmed acute nicotine poisoning with serum nicotine levels of 134 ng/ml and 266 ng/ml, respectively. Nicotine pouches, while promoted as a reduced-harm alternative to tobacco products for adult smokers, are not risk-free products. The distinction between "reduced harm" and "risk-free" is crucial and must be a central point in the discussion on legislative regulation and public health.