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Zig Bigfoot
12-07-2013, 12:39 AM
One of the characters in my WIP has died. Most people think it was a simple heart attack, but one detective suspects murder and has the body sent to the lab for toxicology tests. The lab results come back negative for poisons except for the presence of nicotine, which is not a surprise (because it was known that the character was a smoker who was trying to give cigarettes up and using nicotine patches), so they conclude it was a heart attack. But, it turns out later that someone really did poison him, using nicotine tincture to induce the heart attack.

My questions are 1) is it plausible to use nicotine (ingested, in this case) to induce what looks like a regular heart attack, and

2) would the tox lab detect the elevated levels of nicotine as a matter of course, or is it possible that they missed it. I'm envisioning some sort of procedure that tests positive for the presence of certain drugs, but requires a different test to establish the amount of the drug present, which test would not normally be conducted without cause (i.e., they knew he was using patches, so the presence of nicotine was expected, and not remarkable enough to go onto the (more expensive?) quantitative test).

Thanks for your help!

mirandashell
12-07-2013, 12:47 AM
Having read a lot of Christie, I'm not sure nicotine would induce a heart attack, would it?

mirandashell
12-07-2013, 12:49 AM
This is from Wiki so you might want to double check:


Nicotine poisoning tends to produce symptoms that follow a biphasic pattern. The initial symptoms are mainly due to stimulatory effects and include nausea and vomiting, excessive salivation, abdominal pain, pallor, sweating, hypertension, tachycardia, ataxia, tremor, headache, dizziness, muscle fasciculations, and seizures.[4] After the initial stimulatory phase, a later period of depressor effects can occur and may include symptoms of hypotension and bradycardia, central nervous system depression, coma, muscular weakness and/or paralysis, with difficulty breathing or respiratory failure.

robjvargas
12-07-2013, 12:56 AM
It doesn't seem impossible, but nicotine poisoning seems to be fairly well known and easy to detect.

Here's some info on signs/symptoms from the US Centers for Disease Control (http://www.cdc.gov/niosh/ershdb/EmergencyResponseCard_29750028.html#signs):


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.

More details at the site.

King Neptune
12-07-2013, 01:17 AM
One of the characters in my WIP has died. Most people think it was a simple heart attack, but one detective suspects murder and has the body sent to the lab for toxicology tests. The lab results come back negative for poisons except for the presence of nicotine, which is not a surprise (because it was known that the character was a smoker who was trying to give cigarettes up and using nicotine patches), so they conclude it was a heart attack. But, it turns out later that someone really did poison him, using nicotine tincture to induce the heart attack.

My questions are 1) is it plausible to use nicotine (ingested, in this case) to induce what looks like a regular heart attack, and

That might be possible with a massive does, but nicotine does not produce cardiac arrest. Look for a list of symptoms, such as:
http://en.wikipedia.org/wiki/Nicotine_poisoning#Signs_and_symptoms


2) would the tox lab detect the elevated levels of nicotine as a matter of course, or is it possible that they missed it. I'm envisioning some sort of procedure that tests positive for the presence of certain drugs, but requires a different test to establish the amount of the drug present, which test would not normally be conducted without cause (i.e., they knew he was using patches, so the presence of nicotine was expected, and not remarkable enough to go onto the (more expensive?) quantitative test).

Thanks for your help!Nicotine poisoning was the thing that first got the attention o the chemist who found a test for vegetable alkaloids. That was in France in 1840. If someone died with possible poisoning, there would be tests for vegetable alkaloids, and it would be possible to determine the amounts that the person had gotten (within reason).

Nicotine is a good plot device, and it would still be possible for someone to use it as a murder weapon and not be caught, but the test has been around as long as fax machines have been around, so the murderer will have to be clever or get caught.

asroc
12-07-2013, 01:20 AM
Nicotine won't cause a heart attack (directly).

The symptoms of acute nicotine poisoning and those of an acute MI are pretty different. I doubt anyone would mistake one for the other without any follow-up.

ETA:


That might be possible with a massive does, but nicotine does not produce cardiac arrest. [...]

A cardiac arrest and a heart attack are two different things.

Telergic
12-07-2013, 03:03 AM
If the subject has a heart condition and is in danger of excess stimulation, then nicotine as the trigger for the heart attack might be more plausible than an actual lethal dose that directly poisons.

King Neptune
12-07-2013, 03:53 AM
A cardiac arrest and a heart attack are two different things.

That is true.

King Neptune
12-07-2013, 03:59 AM
If the subject has a heart condition and is in danger of excess stimulation, then nicotine as the trigger for the heart attack might be more plausible than an actual lethal dose that directly poisons.

One of the several symptoms of nicotine poisoning is the constriction of blood vessels, and you could make that fit.

CoolBlue
12-07-2013, 09:24 AM
If your character victim had significant coronary heart disease, this scenario is indeed plausible.

Here is an extract from UpToDate, a clinical reference. I have marked the relevant parts in red. The numbers are to source articles. If you really need them, I could dig them up.

ETA: And no, nicotine would be expected, and not tested for. A quantitative assay would be needed, as opposed to a qualitative. This would only be done if suspected poisoning had occurred, I believe. Not always easy to interpret results, either. Think of the current Yasser Arafat debacle.

HTH
CB

CARDIOVASCULAR EFFECTS — Nicotine is a ganglionic and central nervous system stimulant, the actions of which are mediated via nicotinic cholinergic receptors. Nicotine binds to nicotinic cholinergic receptors that are located in the brain, autonomic ganglia, the adrenal glands, and at neuromuscular junctions [6]. These receptors, which demonstrate diversity in subunit structure, function, and distribution within the nervous system, presumably mediate the complex actions of nicotine described in tobacco users.

The major cardiovascular effect of nicotine is sympathetic neural stimulation [8,9]. Central nervous system-mediated sympathetic stimulation can occur through activation of peripheral chemoreceptors, a direct effect on the brainstem, and effects on caudal portions of the spinal cord. The site that appears to be most sensitive to low levels of nicotine is the carotid chemoreceptor. Peripheral mechanisms include catecholamine release from the adrenal and direct release or enhancement of release of catecholamines from vascular nerve endings.

Nicotine also enhances the release of various neurotransmitters, including epinephrine, norepinephrine, dopamine, acetylcholine, serotonin, vasopressin, glutamate, nitric oxide, calcitonin growth-related peptide, and beta-endorphin [10]. Some of these may contribute to the effects of nicotine on blood vessels.

Biphasic actions are observed depending upon the dose administered. The main effect of nicotine in small doses is stimulation of all autonomic ganglia; with larger doses, initial stimulation is followed by blockade of transmission. Biphasic effects are also evident in the adrenal medulla; discharge of catecholamines occurs with small doses, whereas prevention of catecholamines release is seen with higher doses as a response to splanchnic nerve stimulation.

NICOTINE AND CARDIOVASCULAR RISK — Smoking is an important and established risk for myocardial infarction and other coronary events, including angina pectoris [11-13]. The mechanisms by which cigarette smoking accelerates atherosclerosis and precipitates acute coronary events are complex. The main responsible constituents are combustion products, including oxidizing chemicals, acrolein, butadiene, metals (such as cadmium), polycyclic aromatic hydrocarbons, particulates, and carbon monoxide. Oxidizing chemicals increase free radicals, increase lipid peroxidation, and contribute to several potential mechanisms of cardiovascular disease, including inflammation, endothelial dysfunction, oxidation of LDL, and platelet activation.

Nicotine may also contribute to acute coronary events. There are a number of ways in which nicotine can affect the cardiovascular system to increase the risk of atherosclerosis and cardiovascular events such as myocardial infarction.

Increased myocardial work — Smoking repeatedly produces a transient rise in blood pressure (BP) of approximately 5 to 10 mmHg [14-16]. This effect is most prominent with the first cigarette of the day in habitual smokers. The hemodynamic effects of cigarette smoking are mediated by nicotine which also increases heart rate up to 10 to 20 beats/min after an individual cigarette and on average seven beats per minute throughout the day [16]. (See "Smoking and hypertension".) As a result of the increased myocardial work, myocardial oxygen demands and coronary artery blood flow increase. However, myocardial ischemia may ensue in patients with coronary disease, particularly in the presence of underlying coronary vascular disease when the coronary vasoconstrictive effect of smoking is superimposed (see below).

Despite these acute effects, habitual smokers generally have lower blood pressures than nonsmokers [17,18]. This is seen when blood pressure is measured after a period of nonsmoking, as is usually the case when a smoker is seen in the office or hospital. Ambulatory blood pressure recording shows that smoking increases BP. The mild reduction in BP in smokers may be related to reduced blood volume that is seen as a consequence of nicotine mediated vasoconstriction and possibly decreased body weight, which reflects a nicotine-induced stimulation of energy expenditure [19]. In addition, a vasodilator effect of cotinine, the major metabolite of nicotine, also may contribute to the hypotensive response [20].

Coronary vasoconstriction — In subjects with coronary disease, Doppler measurements of coronary blood flow demonstrate that cigarette smoking constricts epicardial arteries, increases total coronary vascular resistance, and reduces coronary blood flow [21-24]. (See "Clinical use of coronary artery pressure and Doppler flow measurements".) Smoking also reduces coronary vasodilatory flow reserve.

Smoking has also been associated with an increased risk of vasospastic angina and poorer response of recurrent coronary spasm to vasodilator medication. Smoking can produce acute vasospasm during angiography
[23,25]. These effects appear to be mediated by increased catecholamines since the acute increase in coronary vascular resistance can be minimized by alpha-adrenergic blockers [24]. (See "Variant angina".)

wendymarlowe
12-07-2013, 10:28 AM
There's a big difference between "caused something which is obviously not a heart attack; let's look into this" and "oh, he drowned in his hot tub, guess it was probably a heart attack." I'm guessing the best way to give someone nicotine poisoning and not get caught is to make the *symptoms* the cause of death - cause them at a time the victim is likely to be somewhere they're vulnerable (such as near water, working somewhere up on a cliff, etc.) and then the actual cause of death (drowning/falling/etc.) would be easy to determine and the police would be less likely to look at poisoning as a next step.

Cath
12-07-2013, 05:01 PM
CoolBlue - could you give a link to that reference, please.

CoolBlue
12-07-2013, 07:56 PM
CoolBlue - could you give a link to that reference, please.

Not directly. It is a subscription-based service.

Here (http://uptodate.com) is the front page.

Is that what you wanted? Not sure if that is what you mean?

CB

WriteMinded
12-07-2013, 08:21 PM
My questions are 1) is it plausible to use nicotine (ingested, in this case) to induce what looks like a regular heart attack, and

2) would the tox lab detect the elevated levels of nicotine as a matter of course, or is it possible that they missed it. I'm envisioning some sort of procedure that tests positive for the presence of certain drugs, but requires a different test to establish the amount of the drug present, which test would not normally be conducted without cause (i.e., they knew he was using patches, so the presence of nicotine was expected, and not remarkable enough to go onto the (more expensive?) quantitative test).

I can only speak to your first question from personal experience. 1) It would certainly occur to me to use nicotine if my victim were a smoker. A friend, wearing a nicotine patch and continuing to smoke, once induced his own heart attack. He damn near died. So I know death by nicotine is plausible. I also would have a reasonable expectation that a (dead) smoker wearing a patch with high levels of nicotine in his system would likely be ruled an accidental death.

2) I'm guessing that if the lab found no other reason for the person's death they might test nicotine levels and pin the cause of death but still consider it accidental.

:D Pretty good murder weapon, methinks.

Zig Bigfoot
12-08-2013, 04:21 AM
Thanks, all! I think I may be able to make this work, with a little tweaking. The character did have a heart condition, and was out doing yard work before he died. Nobody was present when he died, so there were no symptoms observed and only the appearance of the body post-mortem. The lab results will come back negative for all toxins except nicotine, which will not raise a red flag due to the history of smoking and the heart condition.

King Neptune
12-08-2013, 05:14 AM
Thanks, all! I think I may be able to make this work, with a little tweaking. The character did have a heart condition, and was out doing yard work before he died. Nobody was present when he died, so there were no symptoms observed and only the appearance of the body post-mortem. The lab results will come back negative for all toxins except nicotine, which will not raise a red flag due to the history of smoking and the heart condition.


A test for toxins that found nicotine would also show a level that was considerably higher than a smoker would have. While addiction to tobacco raises tolerance to nicotine, it only raises it to a limited degree. The terminal dosage would have to be at least fifty percent about the dosage for a non-smoker, and that would be a big, red flag waving in front of the medical examiner.