{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T04:14:03Z","timestamp":1791346443019,"version":"4.3.1"},"reference-count":10,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T00:00:00Z","timestamp":1722470400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,3,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Nicotine pouches have emerged as a novel way to administer concentrated nicotine and come as a white powder in flavored, microfiber pouches placed between the cheek and gums to dissolve without requiring spitting. While marketed as a safe alternative to smoking, nicotine pouches have the potential for toxic exposure to users.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case Presentation<\/jats:title>\n                  <jats:p>We present a case of a 21-year-old male with acute nicotine toxicity through repeated administration of nicotine pouches. Over the course of 12 hours, he consumed 15 extra-strength nicotine pouches (10.9 mg per pouch) as a study tool to prepare for the next-day exams. He presented to the emergency department with bizarre behavior requiring admission for persistent confusion and nausea which resolved after 24 hours.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This case represents the first case of acute nicotine toxicity secondary to nicotine pouch use. These pouches are emerging as a novel way to use nicotine and present a serious risk of inadvertent overdose and harm.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Implications<\/jats:title>\n                  <jats:p>Nicotine pouches are emerging as a novel way to use nicotine, and second to e-cigarettes, are the most frequently used nicotine product among youth. These pouches, which lack clear warning labels, are promoted among social media forums and present a serious risk of inadvertent overdose and harm, especially among young adults. Healthcare professionals should be aware of this risk, especially from acute, repeated exposures, and should ensure the public is cautioned appropriately.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ntr\/ntae111","type":"journal-article","created":{"date-parts":[[2024,8,1]],"date-time":"2024-08-01T21:03:11Z","timestamp":1722546191000},"page":"767-768","source":"Crossref","is-referenced-by-count":17,"title":["Nicotine Toxicity From Repeat Use of Nicotine Pouches"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4017-7479","authenticated-orcid":false,"given":"Jessica T","family":"Kent","sequence":"first","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, University of Toronto , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8372-2815","authenticated-orcid":false,"given":"Garrick","family":"Mok","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Department of Emergency Medicine, St. Michael\u2019s Hospital , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Austin","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Medicine, University of Toronto , Toronto, Ontario ,","place":["Canada"]},{"name":"Department of Emergency Medicine, St. Michael\u2019s Hospital , Toronto, Ontario ,","place":["Canada"]},{"name":"Ontario Poison Centre , Toronto, Ontario ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2024,8,1]]},"reference":[{"issue":"4","key":"2025032407550509800_CIT0001","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1080\/15563650.2018.1510503","article-title":"An epidemiologic and clinical description of e-cigarette toxicity","volume":"57","author":"Hughes","year":"2019","journal-title":"Clin Toxicol"},{"issue":"2","key":"2025032407550509800_CIT0002","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1136\/tc-2022-057280","article-title":"Levels of nicotine and tobacco-specific nitrosamines in oral nicotine pouches","volume":"33","author":"Mallock","year":"2024","journal-title":"Tob Control."},{"issue":"5","key":"2025032407550509800_CIT0003","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1136\/tc.2009.033217","article-title":"Divergence between strength indicators in packaging and cigarette engineering: a case study of Marlboro varieties in Australia and the USA","volume":"19","author":"King","year":"2010","journal-title":"Tob Control."},{"issue":"9","key":"2025032407550509800_CIT0004","doi-asserted-by":"crossref","first-page":"2863","DOI":"10.1007\/s00213-022-06172-y","article-title":"Nicotine pharmacokinetics and subjective responses after using nicotine pouches with different nicotine levels compared to combustible cigarettes and moist smokeless tobacco in adult tobacco users","volume":"239","author":"Liu","year":"2022","journal-title":"Psychopharmacology (Berl)."},{"issue":"3","key":"2025032407550509800_CIT0005","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/add.16355","article-title":"Evaluating the effects of nicotine concentration on the appeal and nicotine delivery of oral nicotine pouches among rural and Appalachian adults who smoke cigarettes: a randomized cross-over study","volume":"119","author":"Keller-Hamilton","year":"2024","journal-title":"Addiction."},{"issue":"2","key":"2025032407550509800_CIT0006","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1080\/17425255.2022.2058930","article-title":"Managing intoxications with nicotine-containing e-liquids","volume":"18","author":"Henstra","year":"2022","journal-title":"Expert Opin Drug Metab Toxicol."},{"issue":"6","key":"2025032407550509800_CIT0007","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1001\/jama.2021.10366","article-title":"Nicotine pouch unit sales in the US, 2016-2020","volume":"326","author":"Marynak","year":"2021","journal-title":"JAMA."},{"key":"2025032407550509800_CIT0008","doi-asserted-by":"publisher","first-page":"1","DOI":"10.21203\/rs.3.rs-1693288\/v1","article-title":"Prevalence and frequency of the use of nicotine pouches and its association with stress amongst students of medical and non-medical Universities of Karachi, Pakistan","author":"Khan","year":"2022","journal-title":"Res Square."},{"issue":"7","key":"2025032407550509800_CIT0009","doi-asserted-by":"crossref","first-page":"e37071","DOI":"10.2196\/37071","article-title":"Perceptions of oral nicotine pouches on Reddit: observational study","volume":"24","author":"Shao","year":"2022","journal-title":"J Med Internet Res."},{"issue":"9","key":"2025032407550509800_CIT0010","doi-asserted-by":"crossref","first-page":"1610","DOI":"10.1093\/ntr\/ntad080","article-title":"Nicotine pouch awareness and use among youth, National Youth Tobacco Survey, 2021","volume":"25","author":"Kramer","year":"2023","journal-title":"Nicotine Tob Res."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntae111\/58712264\/ntae111.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/4\/767\/58712264\/ntae111.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/4\/767\/58712264\/ntae111.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T12:25:53Z","timestamp":1742991953000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/27\/4\/767\/7725552"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,1]]},"references-count":10,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2024,8,1]]},"published-print":{"date-parts":[[2025,3,24]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntae111","relation":{},"ISSN":["1469-994X"],"issn-type":[{"value":"1469-994X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2025,4]]},"published":{"date-parts":[[2024,8,1]]}}}