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 μg/L 7 h after admittance and 9,814 μg/L after 12 h. Levels of cotinine in the urine were above >50,000 μg/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.
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