Clin Toxicol (Phila). 2010 Jun 19. [Epub ahead of print]
A case of life-threatening rectal administration of moist snuff.
Knudsen K, Strinnholm M.
Surgical Sciences, Anesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
Case report. We report a case of self-administration of 75 sachets of moist snuff rectally in a previously healthy, 42-year-old man. He presented with symptoms of nausea, discomfort, and dizziness. He had dry and warm skin, a pulse rate of 53 bpm, a mean arterial blood pressure of 135 mmHg and fluctuations in consciousness. The patient was treated with mechanical ventilation because of respiratory insufficiency. No specific anti-nicotinergic treatment was given. Plasma levels of the nicotine metabolite cotinine were 8,691 mug/L 7 h after admittance and 9,814 mug/L after 12 h. Levels of cotinine in the urine were above >50,000 mug/L. The patient developed a mild pneumonia, but he was uneventfully extubated after 12 h of mechanical ventilation. All physiological parameters were restored and he was discharged from hospital after 36 h. Conclusion. Excessive rectal administration of moist snuff may be life threatening. Patients may require intensive care. Long-term sequelae were not seen in this case
My questions are these:
1. Is this simply a case of misinterpeting the label?
2. If not, does the label adequately warn against stuffing 75 snus packets up your behind? And in case language is an issue, is there a graphic illustrating against this use?
3. Ok, one or two could have been an honest mistake, but 75?
4. Could he have picked up the wrong box and meant really to insert 75 normal suppositories?
5. Is this the start of a new trend related to autoerotic asphyxiation -some sort of deviant sex game gone awry?
6. Is it possible that this gentleman had not heard that Guinness had discontinued the nicotine use category?
7. Isn’t this taking product placement a bit far?
8. How long before this shows up on an episode of House?
-Paul L. Bergen