“Dip,” or moist snuff, is a form of smokeless tobacco made from finely ground or shredded tobacco leaves that users typically hold between the lip and gum. This product contains extremely high concentrations of nicotine, with a single gram of tobacco often holding between 10 to 14 milligrams of the compound. Swallowing this tobacco, even in small amounts, introduces a toxic dose of nicotine directly into the digestive system. Nicotine poisoning, or overdose, from ingestion is a severe medical emergency that requires immediate intervention due to the rapid onset of life-threatening systemic effects.
How Nicotine is Absorbed When Swallowed
The danger of swallowing dip stems from the massive amount of nicotine available for absorption through the gastrointestinal tract. When used as intended, nicotine is absorbed relatively slowly through the buccal mucosa, which is the lining of the mouth. This slower absorption rate allows the body to metabolize the compound gradually.
When dip is swallowed, the nicotine passes into the stomach, which is highly acidic. Nicotine is a weak base, meaning that the low pH of the stomach acid protonates the nicotine molecules, temporarily trapping them and slowing the absorption rate initially. This temporary trapping mechanism, however, is quickly overcome as the contents move into the small intestine.
The environment of the small intestine has a much higher pH, which allows the trapped nicotine to rapidly convert back into its uncharged, absorbable form. The small intestine is lined with a vast network of blood vessels and a high surface area, enabling the rapid absorption of a massive dose directly into the bloodstream. This sudden systemic flood triggers the acute and severe toxicity associated with swallowing smokeless tobacco.
Acute Symptoms of Nicotine Overdose
The physiological response to swallowing a toxic amount of nicotine is characterized by a rapid, two-phase progression of symptoms known as Nicotine Overdose Syndrome. The initial phase begins within minutes and is marked by the compound’s powerful stimulatory effects on the nervous system. Early symptoms commonly include nausea, stomach pain, vomiting, and excessive salivation, often leading to rapid fluid loss and dehydration.
The stimulatory effects extend to the cardiovascular system, causing an initial increase in heart rate (tachycardia) and elevated blood pressure (hypertension). Neurological symptoms also manifest quickly, presenting as agitation, confusion, headache, dizziness, pallor, sweating, and muscle twitching.
As the nicotine dose overwhelms the body’s receptors, the second phase of depression and collapse begins. This phase can occur within 30 minutes to four hours following ingestion. The initial cardiovascular stimulation reverses, leading to a dangerous drop in blood pressure (hypotension) and a slowed heart rate (bradycardia).
Nervous system depression causes extreme weakness, loss of full muscle control, and potentially central nervous system depression, which can progress to fainting or coma. The most life-threatening complication is respiratory failure, occurring when the muscles controlling breathing become paralyzed. Death from severe nicotine poisoning is typically due to this respiratory paralysis or cardiovascular collapse.
Immediate Emergency Response and Medical Care
Immediate professional intervention is required for nicotine poisoning. The first step is to immediately call Poison Control or emergency medical services (such as 911 in the United States) for guidance. When calling, be prepared to provide the victim’s age, weight, the approximate amount of tobacco swallowed, and the time of ingestion.
While waiting for medical help to arrive, it is essential to follow the instructions provided by the Poison Control specialist or emergency operator. Do not attempt to induce vomiting unless specifically instructed to do so by a medical professional, as this can increase the risk of aspiration. If the tobacco or saliva is still in the mouth, it should be removed, and any exposed skin should be washed thoroughly.
Upon arrival at a medical facility, treatment is primarily supportive and focused on limiting further nicotine absorption and managing life-threatening symptoms. Activated charcoal may be administered to bind any remaining nicotine in the gastrointestinal tract, preventing it from entering the bloodstream. Intravenous fluids are often used to address dehydration from vomiting and to support low blood pressure.
Medical staff will continuously monitor vital signs, including heart rate, blood pressure, and breathing. Medications like benzodiazepines may be given to control seizures, and atropine can be used to manage a dangerously slow heart rate. If respiratory failure is imminent, the patient will receive airway support, potentially requiring a breathing tube and mechanical ventilation to ensure oxygen delivery.