SHM Converge Scientific Abstract ePoster Gallery-Fatal Flavors Hidden in Plain Sight: A Case of Pediatric Anoxic Brain Injury Secondary to Ingestion of Nicotine Pouches

Fatal Flavors Hidden in Plain Sight: A Case of Pediatric Anoxic Brain Injury Secondary to Ingestion of Nicotine Pouches

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This case report describes a fatal pediatric nicotine pouch ingestion in a 13-month-old boy who was found unresponsive and cyanotic at home. After CPR and ICU admission, he developed seizures, severe encephalopathy, cerebral edema, herniation, and ultimately brain death. Initial findings could have suggested infection or neurologic disease, but toxicology testing revealed markedly elevated nicotine and cotinine levels. Importantly, tobacco-specific biomarkers such as anabasine and nornicotine were negative, supporting ingestion of a synthetic, non-tobacco nicotine product rather than passive exposure.<br /><br />The report highlights the growing popularity of flavored oral nicotine pouches, which are often brightly packaged and attractive to young children. It emphasizes that accidental exposures commonly occur in the home and that even relatively small doses of nicotine can be life-threatening in children. Nicotine toxicity may begin with cholinergic symptoms such as vomiting, tremors, tachycardia, and seizures, then progress to bradycardia, hypotension, coma, and anoxic brain injury.<br /><br />A key point of the report is the diagnostic value of extended toxicology testing. Standard screens may detect nicotine, but biomarkers like anabasine help distinguish tobacco-derived exposure from synthetic nicotine ingestion. The authors recommend considering nicotine pouches in unexplained pediatric encephalopathy, seizures, or cardiac arrest, and stress the need for caregiver education and prevention efforts regarding these hazardous products.

Asset Subtitle

Arghyadeep Ganguly

Meta Tag

Author List Arghyadeep Ganguly, Sarah Jane Brown, Zachary R. Smith

Category Clinical Vignettes

Concept Nicotine Pouches

Concept Pediatric Poisoning

Concept Nicotine Toxicity

Concept Acute Ingestion

Concept Nicotine Use

Distinguished Non-Finalist

Presenter Organization Western Michigan University, Homer Stryker M.D. School of Medicine

Presenting Author Arghyadeep Ganguly

Track Pediatric

Keywords

pediatric nicotine poisoning

nicotine pouch ingestion

toxicology biomarkers

anabasine negative

cotinine elevation

seizures

cerebral edema

brain death

synthetic nicotine

accidental child exposure

Nicotine Pouches

Pediatric Poisoning

Nicotine Toxicity

Acute Ingestion

Nicotine Use