The Poison Review

Unintentional Child Poisonings Through Ingestion of Conventional and Novel Tobacco Products.  Connolly GN et al.   Pediatrics 2010;125:896-899.

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This study looked retrospectively at all cases of children < 6 years of age ingesting only tobacco products that were reported to 61 regional poison control centers in the years 2006-2008.  A total of 13,705 cases were identified, 70% of which occurred in infants < 1 year of age.  Cigarettes were the most common products ingested, followed by smokeless-tobacco preparations.

The authors note that new smokeless tobacco products — such as Camels Orbs — are now being evaluated in test markets. Orbs are small candy-like pellets flavored with mint or cinnamon, packaged in a form that could easily be confused with products such as Tic Tacs.  Each pellet contains an average of 0.83 mg of nicotine, and a pH (7.9) that would increase absorption through oral mucosa.  ingestion of 1 mg nicotine by a child could product toxic symptoms (nausea and vomiting); 1 mg/kg is the estimated minimal pediatric lethal dose.

The availability of these forms of nicotine candy is alarming, and it will be important to monitor poison center reports to see if these products result in more cases of pediatric nicotine toxicity. This article is important reading.  And, not surprisingly, Stephen Colbert has a very funny take on this, along with other recent tox development such as the studies at Johns Hopkins on hallucinogenic therapy for cancer patients and others: