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Get Nebula using my link for 40% off an annual subscription: https://go.nebula.tv/chubbyemu Watch my next video early on Nebula: https://nebula.tv/videos/chubbyemu-a-wife-wiped-back-to-front-instead-of-front-to-back-and-it-destroyed-her-husbands-life Patient CW by Cupcake Windle. Eric by Wolfgang Nelson. Mike by Mike Burling. PA Mike Burling. Review: Dr Katherine Johns Opposite situations: A Husband Was Found With Another Woman: https://youtu.be/qNV5X-GBkR8 A Wife Put Drain Cleaner In Her Husband's Coffee: https://youtu.be/uGv1xasBCmo Music inspired by R Prince, performed by Chubbyemu Music by @Lifeformed ► https://lifeformed.bandcamp.com Medicine ► https://www.youtube.com/playlist?list=PL26HeTCO57qcMQB6CrU6QRzEi9tt9l1FI Amanita muscaria By Onderwijsgek at nl.wikipedia, CC BY-SA 3.0 nl, https://commons.wikimedia.org/w/index.php?curid=1428517 Nicotine is a cholinomimetic, similar to the -stigmines and organophosphates. Increase in ACH increases parasympathetic activity from the Nicotinic Receptors. Expect cholinergic toxidrome, but with a caveat. One of which being that atropine would not be the antidote for this, given its activity on muscarinic acetylcholine receptors and not nicotinic. Atropine may be used for some respiratory symptoms. If we look at nicotine as something that triggers rapid neural and neuromuscular transmissions, then we can understand the end goal of its presence being the mimic of excess acetylcholine. Therefore, we could say that functionally, the end result of a toxicity is similar to an overdose of anti-acetylcholinesterase, but there is a biphasic action in the setting of extreme overdose. First it appears to have a stimulant effect, then it will look more like cholinergic excess afterwards. In particular, nicotinic agonists, or just nicotine alone, paradoxically leads to a constellation of cholinergic + sympathomimetic findings, since nicotinic receptors are located on postganglionic nerves in both the sympathetic and parasympathetic nervous systems. The respiratory depression is what proves to be fatal. These cases are patients who I, or my colleagues have seen. They are de-identified and many instances have been presented in more depth in an academic setting. These videos are not individual medical advice and are for general educational purposes only. I do not give medical advice over the internet. References: America's Poison Centers: E-CIGARETTES AND LIQUID NICOTINE. https://poisoncenters.org/track/ecigarettes-liquid-nicotine Critical Care Toxicology: Diagnosis and Management of the Critically Poisoned Patient. Textbook. Goldfrank's Toxicology. Textbook. Physiology, Autonomic Nervous System. https://www.ncbi.nlm.nih.gov/books/NBK538516 Managing intoxications with nicotine-containing e-liquids. https://www.tandfonline.com/doi/full/10.1080/17425255.2022.2058930 Brain death following ingestion of E-cigarette liquid nicotine refill solution. https://onlinelibrary.wiley.com/doi/full/10.1002/brb3.1744 Nicotine poisoning-related deaths in Seoul Capital Area, Korea, 2014–2021. https://www.sciencedirect.com/science/article/abs/pii/S235200782200275X The Emerging Method of .. by Electronic Cigarette Liquid: a Case Report. https://pmc.ncbi.nlm.nih.gov/articles/PMC5835582/ Fatal .. Attempt by Deliberate Ingestion of Nicotine-containing Solution in Childhood-onset Depression Mediated through Internet .. Guideline: A Case Report. https://pmc.ncbi.nlm.nih.gov/articles/PMC7519620/ Symptomatic bradycardia due to nicotine intoxication. https://pmc.ncbi.nlm.nih.gov/articles/PMC5885240/ American Cancer Society: Nicotine Replacement Therapy to Help You Quit Tobacco. https://www.cancer.org/cancer/risk-prevention/tobacco/guide-quitting-smoking/nicotine-replacement-therapy.html https://www.sandiego.edu/smoke-free/documents/SmokelessTobacco.pdf Cholinesterase Inhibitors Management Strategy: https://www.atsdr.cdc.gov/csem/cholinesterase-inhibitors/atropine.html Synthesis of tetraethyl pyrophosphate (TEPP): from physician Abbot and pharmacist Riegel to chemist Nylen. https://pubmed.ncbi.nlm.nih.gov/26189307/ History of the Use and Epidemiology of Organophosphorus Poisoning. https://link.springer.com/chapter/10.1007/978-1-4471-5625-3_2 Cholinergic Mushroom Poisoning With a Detection of Muscarine Toxin in Urine. https://pmc.ncbi.nlm.nih.gov/articles/PMC10332868/ Plasma nicotine levels after cigarette smoking and chewing nicotine gum. https://pubmed.ncbi.nlm.nih.gov/1268547/ How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. https://pmc.ncbi.nlm.nih.gov/articles/PMC3880486/ Use of e-cigarettes associated with lower sperm counts in a cross-sectional study of young men from the general population. https://academic.oup.com/humrep/article/35/7/1693/5859935 Endogenous testosterone levels and smoking in men. The fifth Tromsø study. https://pubmed.ncbi.nlm.nih.gov/17163954/

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