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Nicotine is an extremely potent poison present in some insecticides, tobacco (wild and cultivated) and in smaller quantities in Laburnum and Hemlock.
It initially causes stimulation and the subsequent blockade of autonomic ganglia, neuromuscular junctions and the central nervous system. The initial symptoms are predominantly cholinergic with nausea, vomiting, salivation, abdominal cramps, headache, fever, mydriasis and tachycardia. Neurological manifestations dominate in serious poisoning with confusion, convulsions, coma, muscle fasciculation and paralysis. Treatment is primarily supportive although atropine may be helpful for muscarinic symptoms. Exposed skin should be washed in the case of known or suspected insecticide poisoning.