Nicotine: Systemic Agent

Colorless to pale yellow, oily liquid that turns brown on exposure to air or light. Also available as a powder.

Nicotine is a naturally occurring toxic chemical found in tobacco plants. It has a fishy odor when warm. Cigarettes, cigars, other tobacco products, and tobacco smoke contain nicotine. Worker exposure may occur during processing and extraction of tobacco. At one time, nicotine was used in the United States as an insecticide and fumigant; however, it is no longer produced or used in this country for this purpose. Nicotine affects the nervous system and the heart. Exposure to relatively small amounts can rapidly be fatal.

• Indoor Air: Nicotine can be released into indoor air as a fine powder or liquid spray (aerosol).
• Water: Nicotine can be used to contaminate water.
• Food: Nicotine can be used to contaminate food.
• Outdoor Air: Nicotine can be released into outdoor air as a fine powder or liquid spray (aerosol).
• Agricultural: If nicotine is released into the air as fine powder or liquid spray (aerosol), it has the potential to contaminate agricultural products.

Nicotine can be absorbed into the body by inhalation, ingestion, skin contact, and mucous membranes.

First Responders should use a NIOSH-certified Chemical, Biological, Radiological, Nuclear (CBRN) Self Contained Breathing Apparatus (SCBA) with a Level A protective suit when entering an area with an unknown contaminant or when entering an area where the concentration of the contaminant is unknown. Level A protection should be used until monitoring results confirm the contaminant and the concentration of the contaminant.
NOTE: Safe use of protective clothing and equipment requires specific skills developed through training and experience.

Select when the greatest level of skin, respiratory, and eye protection is required. This is the maximum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than the AEGL-2.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A Totally-Encapsulating Chemical Protective (TECP) suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, and a hard hat worn under the TECP suit are optional items.

Select when the highest level of respiratory protection is necessary but a lesser level of skin protection is required. This is the minimum protection for workers in danger of exposure to unknown chemical hazards or levels above the IDLH or greater than AEGL-2. It differs from Level A in that it incorporates a non-encapsulating, splash-protective, chemical-resistant splash suit that provides Level A protection against liquids but is not airtight.

• A NIOSH-certified CBRN full-face-piece SCBA operated in a pressure-demand mode or a pressure-demand supplied air hose respirator with an auxiliary escape bottle.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the respiratory protection criteria factors for using Air Purifying Respirators (APR) or Powered Air Purifying Respirators (PAPR) are met. This level is appropriate when decontaminating patient/victims.

• A NIOSH-certified CBRN tight-fitting APR with a canister-type gas mask or CBRN PAPR for air levels greater than AEGL-2.
• A NIOSH-certified CBRN PAPR with a loose-fitting face-piece, hood, or helmet and a filter or a combination organic vapor, acid gas, and particulate cartridge/filter combination or a continuous flow respirator for air levels greater than AEGL-1.
• A hooded chemical-resistant suit that provides protection against CBRN agents.
• Chemical-resistant gloves (outer).
• Chemical-resistant gloves (inner).
• Chemical-resistant boots with a steel toe and shank.
• Escape mask, face shield, coveralls, long underwear, a hard hat worn under the chemical-resistant suit, and chemical-resistant disposable boot-covers worn over the chemical-resistant suit are optional items.

Select when the contaminant and concentration of the contaminant are known and the concentration is below the appropriate occupational exposure limit or less than AEGL-1 for the stated duration times.

• Limited to coveralls or other work clothes, boots, and gloves.

• Nicotine decomposes on heating, producing nitrogen oxides, carbon monoxide, and other highly toxic fumes.
• Nicotine reacts violently with strong oxidants.
• Nicotine is incompatible with strong acids
• Nicotine will attack some forms of plastics, rubber, and coatings.

• Above 203°F (95°C), explosive vapor/air mixtures may be formed.
• Lower explosive (flammable) limit in air (LEL), 0.7%; upper explosive (flammable) limit in air (UEL), 4.0%.
• Containers may explode when heated.

• Nicotine is combustible when exposed to heat or flame.
• Fire will produce irritating, corrosive, and/or toxic gases.
• For small fires, use dry chemical, carbon dioxide, or water spray.
• For large fires, use water spray, fog, or regular foam. Move containers from the fire area if it is possible to do so without risk to personnel. Dike fire control water for later disposal; do not scatter the material. Use water spray or fog; do not use straight streams.
• For fire involving tanks or car/trailer loads, fight the fire from maximum distance or use unmanned hose holders or monitor nozzles. Do not get water inside containers. Cool containers with flooding quantities of water until well after the fire is out. Withdraw immediately in case of rising sound from venting safety devices or discoloration of tanks. Always stay away from tanks engulfed in fire.
• For massive fire, use unmanned hose holders or monitor nozzles; if this is impossible, withdraw from the area and let the fire burn.
• Run-off from fire control or dilution water may be corrosive and/or toxic, and it may cause pollution.
• If the situation allows, control and properly dispose of run-off (effluent).

• If a tank, rail car, or tank truck is involved in a fire, isolate it for 0.5 mi (800 m) in all directions; also consider initial evacuation for 0.5 mi (800 m) in all directions.
• This agent is not included in the DOT ERG 2004 Table of Initial Isolation and Protective Action Distances.
• In the DOT ERG 2004 orange-bordered section of the guidebook, there are public safety recommendations to isolate a nicotine (Guide 151) spill or leak area immediately for at least 150 ft (50 m) for liquids and 75 ft (25 m) for solids in all directions.

• At 68°F (20°C) evaporation of nicotine can quickly cause hazardous air conditions in small enclosed spaces.
• Nicotine readily absorbs moisture from the air (hygroscopic).
• Nicotine is light sensitive (photosensitive) and will gradually turn brown on exposure to air or light.

• OSHA: Not established/determined
• NIOSH: 2544, 2551

• AIR MATRIX
  ASTM [1996]. Standard test method for nicotine and 3-ethenylpyridine in indoor air. West Conshohocken PA: American Society for Testing and Materials. ASTM D 5075-96.de Koning JA, Blokker P, Jungel P, Alkema G, Brinkman UAT [2002]. Automated liner exchange—a novel approach in direct thermal desorption—gas chromatography. Chromatogr 56(3-4):185-190.Gottscho AM, Lin JL, Duck WN, Losty TA [1988]. Nicotine analysis of commercial tobacco products. J Assoc Off Anal Chem 71(6):1110-1115.

  Kuusimaki L, Pfaffli P, Froshaug M, Becher G, Dybing E, Peltonen K [1999]. Determination of nicotine as an indicator of environmental tobacco smoke in restaurants. Am J Ind Med 2(Suppl 1):152-154.

  Li Y, Liu G, Mu W, Zhang Y, Zhang J, He J [1993]. Gas chromatographic analysis of nicotine in indoor air. Hua Xi Yi Ke Da Xue Xue Bao 24(20):209-212.

  Ogden MW, Heavner DL, Foster TL, Maiolo KC, Cash SL, Richardson JD, Martin P, Simmons PS, Conrad FW, Nelson PR 91996]. Personal monitoring system for measuring environmental tobacco smoke exposure. Environ Tech 17(3):239-250.

  Ogden MW, Malolo KC [1992]. Comparative evaluation of diffusive and active sampling systems for determining airborne nicotine and 3-ethenylpyridine. Environ Sci Technol 26:1226-1234.

  Pendergrass SM, Krake AM, Jaycox LB [2000]. Development of a versatile method for the detection of nicotine in air. Am Ind Hyg Assoc J 61:469-472.

  Phillips K, Bentley MC [2001]. Seasonal assessment of environmental tobacco smoke and respirable suspended particle exposures for nonsmokers in Bremen using personal monitoring. Environ Int 27(1):69-85.

  Rothberg M, Heloma A, Svinhufvud J, Kahkonen E, Reijula K [1998]. Measurement and analysis of nicotine and other VOCs in indoor air as an indicator of passive smoking. Ann Occup Hyg 42( 2):129-134.

  Sung-Ok B, Yoon-Shin K, Perry R [1997]. Indoor air quality in homes, offices, and restaurants in Korean urban areas—indoor/outdoor relationships. Atmos Environ 31(4):529-544.

• OTHER
  No references were identified for this sampling matrix for this agent.
• SOIL MATRIX
  Lochmann H, Bazzanella A, Kropsch S, Bachmann K [2001]. Determination of tobacco alkaloids in single plant cells by capillary electrophoresis. J Chromatogr A 917(1-2):311-317.
• SURFACES
  Garrigues JA, P?rez-Ponce A, Garrigue S, de la Guardia M [1998]. Fourier-transform infrared determination of nicotine in tobacco samples by transmittance measurements after leaching with CHCl3. Anal Chim Acta 373(1):63-71.Pichini S, Altieri I, Pellegrini M, Pacifici R, Zuccaro P [1997]. Hair analysis for nicotine and cotinine: Evaluation of extraction procedures, hair treatments, and development of reference material. Forensic Sci Int 84(1-3):243-252.
• WATER
  Ayers GP, Selleck PW, Gillett RW, Keywood MD [1998]. Determination of nicotine in water by gradient ion chromatography. J Chromatogr A 824(2):241-245.Lewis LJ, Lamb JD, Eatough DJ, Hansen LD, Lewis EA [1990]. The determination of nicotine and cotinine by ion pair reversed-phase chromatography. J Chromatogr Sci 28(4):200-203.Nystrom L, Pettersson M, Rangemark C [1997]. Simple and sensitive method for determination of nicotine in plasma by gas chromatography. J Chromatogr B 701(1):124-128.

Nicotine poisoning typically (but not always) produces toxicity in two phases: stimulation/excitation (early) followed quickly by inhibition/depression (late). Some patient/victims may only exhibit late phase effects. Onset of physical effects is dependent on route of exposure. Early phase findings occur within 15 minutes to 1 hour. Vomiting is the most common symptom of nicotine poisoning. Late phase findings occur within 30 minutes to 4 hours. The duration of symptoms is about 1 to 2 hours following mild exposure, and up to 18 to 24 hours following severe exposure. Death may occur within 1 hour after severe exposure.

At low concentrations, nicotine causes tremor and increases in heart rate, respiratory rate, blood pressure, and level of alertness. More severe exposures cause muscle fasciculations (involuntary twitching), seizures, and abnormal heart rhythms; these effects are followed by multi-system organ depression including slow heart rate (bradycardia), low blood pressure (hypotension), and paralysis of the muscles that control breathing. Vomiting occurs in more then 50% of symptomatic patient/victims. Death may occur, and is typically due to paralysis of the muscles that control breathing, a build-up of fluid in the airways (bronchorrhea), and failure of the heart and blood vessels (cardiovascular collapse).

• Irritation and redness.
• Pure nicotine in the eye may cause severe pain and inflammation of the conjuctiva.
• Severe exposure may cause opacification of the cornea.

• Early phase: nausea, vomiting (emesis), abdominal pain, and increased salivation; fluid build-up in the airways (bronchorrhea); rapid, heavy breathing (hyperpnea); high blood pressure (hypertension), rapid heart rate (tachycardia), and generalized narrowing of the blood vessels (vasoconstriction) with pale skin; and headache, dizziness, confusion, agitation, restlessness, loss of balance and difficulty walking, and visual and hearing (auditory) distortions.
• Late phase: diarrhea (particularly at larger doses); shallow breathing (hypoventilation), no breathing (apnea), low blood pressure (hypotension), slow heart rate (bradycardia), abnormal heart rhythms (dysrhythmias), and shock (critically low blood pressure); and loss of normal reflexes (hyporeflexia), loss of normal muscle tone (hypotonia), lethargy, weakness, paralysis, and coma (long-term loss of consciousness).
• Possible burning sensation in the mouth, throat, and stomach.
• Absorption of nicotine by ingestion is not complete because acid in the stomach prevents nicotine from being very well absorbed.

• See Ingestion Exposure.

• Irritation and redness (erythema).
• Occupational handling of tobacco leaves may result in green tobacco sickness caused by dermal absorption of nicotine.
• Absorption through the skin and particularly through the mucous membranes may result in whole-body (systemic) toxicity.
• Some patient/victims may exhibit an allergic reaction to nicotine.
• See Ingestion Exposure.

The purpose of decontamination is to make an individual and/or their equipment safe by physically removing toxic substances quickly and effectively. Care should be taken during decontamination, because absorbed agent can be released from clothing and skin as a gas. Your Incident Commander will provide you with decontaminants specific for the agent released or the agent believed to have been released.

The following are recommendations to protect the first responders from the release area:

• Position the decontamination corridor upwind and uphill of the hot zone. The warm zone should include two decontamination corridors. One decontamination corridor is used to enter the warm zone and the other for exiting the warm zone into the cold zone. The decontamination zone for exiting should be upwind and uphill from the zone used to enter.
• Decontamination area workers should wear appropriate PPE. See the PPE section of this card for detailed information.
• A solution of detergent and water (which should have a pH value of at least 8 but should not exceed a pH value of 10.5) should be available for use in decontamination procedures. Soft brushes should be available to remove contamination from the PPE. Labeled, durable 6-mil polyethylene bags should be available for disposal of contaminated PPE.

The following methods can be used to decontaminate an individual:

• Decontamination of First Responder:
  • Begin washing PPE of the first responder using soap and water solution and a soft brush. Always move in a downward motion (from head to toe). Make sure to get into all areas, especially folds in the clothing. Wash and rinse (using cold or warm water) until the contaminant is thoroughly removed.
  • Remove PPE by rolling downward (from head to toe) and avoid pulling PPE off over the head. Remove the SCBA after other PPE has been removed.
  • Place all PPE in labeled durable 6-mil polyethylene bags.
• Decontamination of Patient/Victim:
  • Remove the patient/victim from the contaminated area and into the decontamination corridor.
  • Remove all clothing (at least down to their undergarments) and place the clothing in a labeled durable 6-mil polyethylene bag.
  • Thoroughly wash and rinse (using cold or warm water) the contaminated skin of the patient/victim using a soap and water solution. Be careful not to break the patient/victim’s skin during the decontamination process, and cover all open wounds.
  • Cover the patient/victim to prevent shock and loss of body heat.
  • Move the patient/victim to an area where emergency medical treatment can be provided.

Initial treatment is primarily supportive.

Use of atropine is a mainstay of treatment for cholinergic toxicity.
For pediatric patient/victims administer 0.02 mg/kg of atropine intravenously (IV). Repeat as necessary.
For adult patient/victims administer 2 to 3 mg intravenously (IV). Repeat as necessary.

• Immediately remove the patient/victim from the source of exposure.
• Immediately wash eyes with large amounts of tepid water for at least 15 minutes.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• Ensure that the patient/victim has an unobstructed airway.
• Do not induce vomiting (emesis).
• Patient/victims often vomit spontaneously.
• Only if airway is secured administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
• Do not administer antacids; alkaline conditions improve the absorption of nicotine.
• Monitor heart function and evaluate for low blood pressure (hypotension), abnormal heart rhythms (dysrhythmias), and reduced respiratory function (respiratory depression).
• Evaluate for low blood sugar (hypoglycemia), electrolyte disturbances, and low oxygen levels (hypoxia).
• If evidence of shock or low blood pressure (hypotension) is observed, begin intravenous (IV) fluid administration. If fluid administration fails to reverse hypotension, dopamine and norepinephrine may be used.
• If seizures occur, treat them with benzodiazepines.
• Maintain adequate hydration and urine output.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• Evaluate respiratory function and pulse.
• Ensure that the patient/victim has an unobstructed airway.
• Only if the airway is secured, administer charcoal as a slurry (240 mL water/30 g charcoal). Usual dose: 25 to 100 g in adults/adolescents, 25 to 50 g in children (1 to 12 years), and 1 g/kg in infants less than 1 year old.
• If shortness of breath occurs or breathing is difficult (dyspnea), administer oxygen.
• Assist ventilation as required. Always use a barrier or bag-valve-mask device.
• If breathing has ceased (apnea), provide artificial respiration.
• See the Ingestion section for first aid recommendations.
• Seek medical attention immediately.

• Immediately remove the patient/victim from the source of exposure.
• See the Decontamination section for patient/victim decontamination procedures.
• If signs of systemic exposure develop, see the Ingestion section for first aid recommendations.
• Seek medical attention immediately.

Because activated charcoal effectively binds nicotine and nicotine appears to be cycled between the liver and the digestive tract as it is being metabolized (enterohepatic recirculation), administration of multiple doses of activated charcoal (up to 4, 1 – 2 hours apart) may be effective. Respirations should be supported by intubation and mechanical ventilation as needed.

In general, timely and adequate respiratory and cardiovascular support will lead to full recovery without adverse lasting effects (sequelae).

Nicotine is a teratogen (capable of causing birth defects). Other developmental toxicity or reproductive toxicity risks are unknown. The information about nicotine as a carcinogen is inconclusive.

• Consult with the Incident Commander regarding the agent dispersed, dissemination method, level of PPE required, location, geographic complications (if any), and the approximate number of remains.
• Coordinate responsibilities and prepare to enter the scene as part of the evaluation team along with the FBI HazMat Technician, local law enforcement evidence technician, and other relevant personnel.
• Begin tracking remains using waterproof tags.

• Wear PPE until all remains are deemed free of contamination.
• Establish a preliminary (holding) morgue.
• Gather evidence, and place it in a clearly labeled impervious container. Hand any evidence over to the FBI.
• Remove and tag personal effects.
• Perform a thorough external evaluation and a preliminary identification check.
• See the Decontamination section for decontamination procedures.
• Decontaminate remains before they are removed from the incident site.

The following methods can be used to decontaminate the environment/spillage disposal:

• Do not touch or walk through the spilled agent if at all possible. However, if you must, personnel should wear the appropriate PPE during environmental decontamination. See the PPE section of this card for detailed information.
• Keep combustibles (e.g., wood, paper, and oil) away from the spilled agent. Use water spray to reduce vapors or divert vapor cloud drift. Avoid allowing water runoff to contact the spilled agent.
• Do not direct water at the spill or the source of the leak.
• Stop the leak if it is possible to do so without risk to personnel, and turn leaking containers so that gas rather than liquid escapes.
• Prevent entry into waterways, sewers, basements, or confined areas.
• Isolate the area until gas has dispersed.
• Ventilate the area.

Agents can seep into the crevices of equipment making it dangerous to handle. The following methods can be used to decontaminate equipment:

• Not established/determined