nicotine poisoning in babies
And it's not easy to disguise nicotine in food. Always storing nicotine products in their original container. For emergency advice and paediatric or neonatal ICU transfers, call For advice and inter-hospital transfer (including ICU level) ring the Sick Child Hotline (PIPER): 9345 7007. Poisonous fumes. All are technically capable of causing poisoning if taken in large enough quantities. 2005-2023 Healthline Media a Red Ventures Company. 9, 10 In high enough doses nicotine can be deadly. Poisoning can occur if this substance is swallowed, inhaled or absorbed through the skin. Children with friends who smoke are also . Poisoning occurs when these toxins are ingested (more common with younger children) or inhaled. 137 While it may seem counterintuitive, nicotine replacement therapies (NRTs), such as gum, patches, inhalers, nasal spray and lozenges can help tobacco users quit. Nicotine in smokeless tobacco products that are used during pregnancy can affect how a baby's brain develops before birth. As little as 1 milligram (mg) of nicotine, a very small amount, can cause symptoms in an infant. Nicotine poisoning can cause nausea, vomiting, and headaches. Nicotine poisoning can occur in two stages: early phase and late phase. In theory, then, consuming a few e-cigarettes could be fatal. Nicotine is a bitter-tasting compound that naturally occurs in large amounts in the leaves of tobacco plants. [15] Minor effects correlated with e-cigarette liquid poisoning were tachycardia, tremor, chest pain and hypertension. Infants and children are naturally curious, touching and tasting just about everything including tobacco products. Discuss with toxicologist. Nicotine is a poison. ALWAYS store cigarettes and other nicotine products where children cannot see or reach them. Call 911 if your child has difficulty breathing, seizures or loss of consciousness. The estimated lower limit of a lethal dose of nicotine has been reported as between 500 and 1000 mg. [7] Children may become ill following ingestion of one cigarette; [8] ingestion of more than this may cause a child to become severely ill. [5] [9] The nicotine in the e-liquid of an electronic cigarette can be hazardous to infants and children, through accidental ingestion or skin contact. Severe cases of toxicity can lead to heart failure or death. Initial stimulatory effects occur within minutes and may include agitation, diaphoresis, nausea and vomiting, tachycardia, bronchoconstriction and seizures. For higher-risk exposures, consider: Patients who are either asymptomatic following exposure or who are recovering from gastrointestinal symptoms only should be monitored for 4 hours prior to discharge. She was admitted to the pediatric intensive care unit where she remained minimally responsive for the rest of the night. This prevents the possibility of choking on vomit. All patients with significant ingestions or who have required initial resuscitation. Symptoms depend on the substance ingested, but the most telltale signs of a medication overdose in a child are vomiting, diarrhea and/or drooling. Last medically reviewed on August 7, 2017, If you have allergic reactions to tobacco products or tobacco smoke, you might have a nicotine allergy. [27] They recovered (helped by vomiting), but an ingestion apparently of about 10,000mg was fatal, as was an injection. Today, nicotine poisoning has become a growing concern because of new nicotine products on the market, particularly electronic cigarettes (e-cigarettes) and pure liquid nicotine. Poison control also has a website tool to get help online. Flush the child's eye by holding the eyelid open and pouring a steady stream of room temperature water into the inner corner for 15 minutes. [14] At least at "normal" levels, as nicotine in the human body is broken down, it has an approximate biological half-life of 12hours. Although cigarette smoking is legal, pregnant women who continue to smoke during pregnancy may have babies who exhibit withdrawal symptoms similar to babies who have withdrawal symptoms from heroin or crack, explains Science Daily. In young children, nausea and vomiting are the most notable symptoms of nicotine poisoning. 2014. Carbon monoxide (CO) is a colorless, odorous, poisonous gas that is emitted from fuel-burning appliances that are not functioning properly or are not well-vented, such as gas ranges/ovens, furnaces, space heaters, clothes dryers, gas water heaters, portable generators, wood-burning fireplaces and stoves, as well as cars. The addiction is physical, mental, and. More information Vaping: Dangerous, Available & Addicting However, the leading causes of nicotine poisoning are smokeless tobacco products (chew and snuff) and liquid nicotine thats used in e-cigarettes. If you think a child has been exposed to nicotine in some way, seek emergency medical care. Small children may be attracted to the pleasant smell of these products, assuming that they must taste good too. zolpidem), opioid narcotics (e.g. Using more than one nicotine-containing product can also increase your risk. Increased levels of nicotine or cotinine (nicotine metabolite) can be detected in urine or blood. With an estimated median lethal dose between 1 and 13 mg. Small volumes may cause life-threatening toxicity in children. These include nausea and vomiting, excessive salivation, abdominal pain, sweating, hypertension, faster heart rate, tremors, headaches, dizziness, and sometimes seizures. Acute nicotine poisoning usually occurs in young children who accidentally chew on nicotine gum or patches. This article reviews all you need to, Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. [4][5][6] Smoking excessive amounts of tobacco has also led to poisoning; a case was reported where two brothers smoked 17 and 18 pipes of tobacco in succession and were both fatally poisoned. She began her writing career in 2005, focusing on pregnancy and health. or. 2019;28(1):115-116. doi:10.1136/tobaccocontrol-2018-054273, Mishra A, Chaturvedi P, Datta S, Sinukumar S, Joshi P, Garg A. Standard procedures and supportive care, including cardiorespiratory monitoring. digoxin), blood thinners (e.g. Nicotine poisoning refers to toxicity related to nicotine products. Shallow breathing, difficulty breathing, respiratory failure. Liquid nicotine and smokeless tobacco products are the leading causes of nicotine poisoning. Brown Medical School explains that newborns exposed to nicotine exhibit symptoms such as jitteriness and excitability. In young children, alcohol poisoning symptoms can include low blood sugars, which can lead to loss of consciousness, convulsions and coma. Liquid nicotine poisoning symptoms Vomiting A fast heartbeat Jittery and unsteady appearance Difficulty breathing Increased saliva If you suspect your child was exposed to liquid nicotine that was spilled on the skin or swallowed, call the Poison Center hotline: 800-222-1222 immediately. Install battery-operated carbon monoxide detectors in your home, and check or replace batteries when changing the time on clocks each spring and fall. A recent increase in poisonings is due to liquid nicotine, a product in the popular e-cigarette. At low doses nicotine causes stimulatory effects on these receptors, however, higher doses or more sustained exposures can cause inhibitory effects leading to neuromuscular blockade.[4][30]. FDA Approves Low Nicotine Cigarette: Will It Help? (note: it may be difficult to determine true concentration of imported liquid nicotine products), Gastrointestinal nausea and vomiting, abdominal pain, salivation, Respiratory shortness of breath, bronchorrhoea, bronchoconstriction / wheeze, Neurologic agitation, fasciculation, seizures, CVS bradycardia, arrhythmia, hypotension, shock, Neurologic lethargy, muscle paralysis, stupor, coma. Call poison control for further instructions. According to Dr. Sears, these newborns may have a lower level of mental performance by the time they are a year old and lower I.Q. 50 Remember, there is no antidote for nicotine poisoning. Vet Hum Toxicol. Do not follow any packaging instructions regarding poisoning, as these are often outdated. Sweating. Poisoning can happen when using cigarettes, e-cigarettes, or a a smoking cessation product at the same time. [18] Approximately 0.1% of cases developed life-threatening symptoms. Amber Canaan has a medical background as a registered nurse in labor and delivery and pediatric oncology. Hookah smoke poses dangers linked to secondhand smoke. Protect your skin, especially when using liquid nicotine. Last reviewed by a Cleveland Clinic medical professional on 10/25/2021. We avoid using tertiary references. With Jerry Orbach, Benjamin Bratt, S. Epatha Merkerson, Sam Waterston. The symptoms of nicotine poisoning are caused by effects at nicotinic cholinergic receptors. If you do use, dont leave these products out; return them to childproof storage when finished. Nicotine is a natural toxic substance found in tobacco products. The Neurological Institute is a leader in treating and researching the most complex neurological disorders and advancing innovations in neurology. Early signs are: Headache Dizziness Sleepiness As the exposure continues, possible additional symptoms include: Nausea Vomiting Heart palpitations Unconsciousness What about lead poisoning? 2015;36(1):24-31. doi:10.4103/0971-5851.151771. Intravenous fluids (IV) fluids to treat low blood pressure. Vomiting is the most common symptom of nicotine poisoning. Nicotine poisoning results from too much nicotine. TOBACCO AND LIQUID NICOTINE Each year, America's Poison Centers answer thousands of calls about exposures to tobacco products like cigarettes, e-cigarettes, and chewing tobacco. She has a weakness for milk chocolate and succulent plants that dont need regular watering. Her defense tries to create reasonable doubt by emphasizing the neglect of the baby's working mother. Nicotine in third-hand smoke, the residue from tobacco smoke that clings to virtually all surfaces long after a cigarette has been extinguished, reacts with the common indoor air pollutant nitrous acid to produce dangerous carcinogens. These include e-cigarettes (vaping) and pure liquid nicotine. [11], People who harvest or cultivate tobacco may experience Green Tobacco Sickness (GTS), a type of nicotine poisoning caused by skin contact with wet tobacco leaves. Acetaminophen is a pain-relieving (analgesic) and fever-treating (antipyretic) medication that can be obtained over-the-counter. Treatment of nicotine poisoning may include activated charcoal to try to reduce absorption of nicotine in your intestines. 7. Nicotine is the addictive element in tobacco products. Keep all drugs in medicine cabinets or other childproof cabinets that young children cant access. A doctor may provide activated charcoal. Calls to poison control centers about e-cigarettes are rising, the CDC says. A number of harmful chemicals have been detected in cigarettes, including: arsenic cyanide. Orygen Youth Health:1800 888 320, Recreational poisoning: Referral to YoDAA, Victoria'sYouthDrug andAlcoholAdvice service: 1800 458 685, 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Liquid nicotine cartridge (used in e-cigarette)*, Mild nicotine exposures may result in gastrointestinal symptoms only, Larger doses may be rapidly absorbed and can cause severe toxicity resulting in seizures, cardiovascular collapse and coma, Liquid nicotine solutions used in e-cigarette devices are often highly-concentrated. Nicotine, which is found in cigarettes, cigars, chewing tobacco and nicotine gum, can also cause poisoning when ingested by small children. The child was transported to the hospital where she was given oxygen. Increased salivation. Cotinine is an active metabolite of nicotine that remains in the blood for 1820hours, making it easier to analyze due to its longer half-life. We do not endorse non-Cleveland Clinic products or services. Factually reviewed by Dr. Seran Kim, board-certified Emergency Physician, on June 21, 2021. American Association of Poison Control Centers. Children often imitate adults. The behavior of a newborn exposed to nicotine is similar to the behavior of a newborn exposed to illicit drugs such as cocaine. You'll get early symptoms within the. Clinical description After oral ingestion of nicotine, signs and symptoms of nicotine poisoning mimic those for nerve agent or organophosphate poisoning and typically include excess oral secretions, bronchorrhea, diaphoresis, vomiting (common, especially among children), diarrhea, abdominal cramping, confusion, and convulsions. The National Institute for Occupational Safety and Health (NIOSH). Dr. Sears explains that nicotine reduces the amount of oxygen-rich blood that flows to a baby in the womb. Keeping all tobacco products, especially products containing liquid nicotine, out of reach and out of sight of children and pets. When swallowed, they become lodged in a childs upper esophagus, where they erode the tissue, causing life-threatening damage in less than two hours. Other forms include skin patches, injectables and eye drops. Healthline Media does not provide medical advice, diagnosis, or treatment. Cosmetics and personal care products are the most common substances implicated in pediatric poisonings. All tobacco products contain nicotine and are harmful to your health. Its unlikely; however, its not impossible. 1988, Feb; 30(1): 20-22. For poison emergencies or questions call the Minnesota Poison Control System at 1 . Cleveland Clinic is a non-profit academic medical center. metoprolol, verapamil), sleeping aids (e.g. It is typically caused by liquid nicotine ingestion and can lead to overdose and even fatality. Hair color, permanents and relaxers are also dangerous in small amounts (even those without lye) and can cause severe vomiting and burns to the esophagus and stomach. Third-hand vapors from e-cigarettes can stick to clothing, carpet, and other fabrics. . Treatment is mainly supportive and further care can include control of seizures with the administration of a benzodiazepine, intravenous fluids for hypotension, and administration of atropine for bradycardia. She believes the key to parenting survival is surrounding yourself with other families and raising kids as a village. Because of . According to the American Academy of Pediatrics, as little as one teaspoon of liquid nicotine can be fatal to a 26-pound child. Most cases of nicotine poisoning among children result from their ingestion of cigarettes or cigars (2). The management of toxic plant ingestions in children will be reviewed here. Increased blood pressure. Chewing and snorting tobacco releases more nicotine into the body than smoking. The Food and Drug Administration on Tuesday authorized the sale of two new reduced nicotine cigarettes. Calculate likely nicotine dose in mg/kg. Some common examples include analgesics (e.g. Poison Control is frequently called about children who swallow discarded cigarette butts. Nicotine is very poisonous. Many common indoor and outdoor house plants contain toxins and, when ingested, can cause symptoms ranging from throat irritation, nausea, vomiting or diarrhea to blistering skin, difficulty breathing, delirium, convulsions or even death. Eating more cigarettes may make a child severely ill. Electronic cigarettes (e-cigarettes) are devices made to resemble cigarettes. A U.S. analysis identified 1768 cases of poisoning in . The National Institute for Occupational Safety and Health (NIOSH). [15] During the same period, the ten most frequent adverse effects to e-cigarettes and e-liquid reported to US poison control centers were vomiting (40.4%), eye irritation or pain (20.3%), nausea (16.8%), red eye or conjunctivitis (10.5%), dizziness (7.5%), tachycardia (7.1%), drowsiness (7.1%), agitation (6.3%), headache (4.8%), and cough (4.5%). Poison Control will then tell you if you can safely watch your child at home. [16] Minor, moderate, and serious adverse effects involved adults and young children. However, some encounters arent witnessed, and you need to have a high level of suspicion if your child has other signs, such as a strange smell on their breath, atypical drooling or unusual stains on their clothes. Childhood exposures often occur due to exploratory behavior. Note that not all concerning medications have to be in pill or syrup form. It can cause nausea, vomiting, or seizures. Seizures can begin in as little as 20 - 30 minutes. Symptoms of nicotine poisoning in babies can include: Grey skin color, loose stools Increased heart rate Restlessness (a baby might wriggle and squirm or look as if they are trying to tread water or seem very tired but have difficulty keeping their eyes shut) Vomiting after a feeding Reported exposure to this solution in 10 children resulted in hospital evaluation in 7 and mild nicotine poisoning . Nicotine patches can be poisonous if a child ingests them or if they come in contact with the skin. The AAPCC recommends the following measures: If youre interested in getting rid of all your nicotine products entirely, see your doctor for advice. E-cigarettes (which contain liquid nicotine) and nicotine patches can be poisonous if contents are ingested or come into direct contact with the skin. Nicotine is rapidly absorbed after ingestion and inhalation. Some people are allergic to nicotine and do experience symptoms of allergies to nicotine products, but the resulting symptoms are not as . Any child ingesting more than one whole cigarette or more than three butts requires medical assessment. Take measures to ensure you dont use more than one source of nicotine at a time, and keep nicotine and tobacco away from children. Acute nicotine poisoning is characterized by rapid onset of symptoms that may be severe when large amounts have been ingested (2). Report: Children at high risk of nicotine poisoning, injuries working on tobacco farms. Tobacco workers report vomiting, nausea, headache, dizziness, skin rashes For significant skin exposure wash affected area with soap and water. E-liquid products are not always labelled accurately and there is no guarantee that a product does not contain nicotine. While not seemingly attractive substances to taste, hydrocarbons can be ingested by curious toddlers and aspirated, causing pneumonitis, or an inflammation of the lungs. fentanyl) and antihistamines (e.g. When not working, she can be found hiking, reading or embarrassing her kids with her hip-hop dancing. Nicotine is specific for nicotinic cholinergic receptors only and has some, but not all of the symptoms of organophosphate poisoning. This new potential health hazard was revealed in a multi-institutional study led by researchers with Berkeley Lab. [17] More serious effects were bradycardia, hypotension, nausea, respiratory paralysis, atrial fibrillation and dyspnea. Poisoning from other illicit substances, such as cocaine, methamphetamine, ecstasy, synthetic cannabinoids (known as synthetic marijuana, K2 or spice) or synthetic cathinones (found in bath salts) can also cause irreparable harm when ingested. Nicotine poisoning and overdose: How to prevent it. [4] Acidifying the urine could theoretically enhance nicotine excretion,[31] although this is not recommended as it may cause complications of metabolic acidosis. Nicotine is a bitter-tasting compound that naturally occurs in large amounts in the leaves of tobacco plants. Atlanta, GA; 2013 Mar 25 [cited 2013 Jun 6]. [17] The exact correlation is not fully known between these effects and e-cigarettes. The late phase occurs within 30 minutes to four hours. Babylist editors love baby gear and independently curate their favorite products to share with you. You also shouldnt give them any food or liquids. [33], "Nicotiana glauca (tree tobacco) intoxication--two cases in one family", "How much nicotine kills a human? At higher doses, a second phase involving bradycardia, hypotension, respiratory failure and coma may supervene 1 to 4 hours after exposure. Keep chemical products in their original bottles or containers. Not all adults are vulnerable to nicotine poisoning. An 8-month-old child swallowed two old cigarette butts while in the care of a sitter. Symptoms include vomiting, rapid heart rate, unsteadiness and increased salivation. Nail products, including nail polish, nail glue and nail remover, may contain acetone, which if ingested in large quantities mimics the symptoms of alcohol poisoning. CNS depression in an infant after the ingestion of tobacco: a case report. Nicotine is an agonist at nicotinic acetylcholine receptor which are present in the central and autonomic nervous systems, and the neuromuscular junction. tea tree oil), herbals and vitamins (e.g. [15] Most of the e-cigarette calls were a minor effect. If you purchase e-cigarettes and nicotine refill products, store them out of reach of your children and pets. Nicotine poisoning can occur with any form of nicotine-cigarette smoking, e-cigarettes, chewing tobacco and snuff, and even nicotine patches. Children who grow up with parents who smoke are more likely to become smokers. Smokers Double Their Quit Rate By Wearing Nicotine Patch Before Stopping. . Our website services, content, and products are for informational purposes only. Some children and toddlers who come in contact with e-cigarette devices or liquid nicotine have become very ill; some even requiring emergency department visits with nausea and vomiting being the most significant symptoms. Study finds stronger nicotine dependency associated with higher risk of lung cancer. However, as we mentioned above, it is highly unlikely to do so with tobacco-free nicotine pouches, nicotine tablets, nicotine lozenges, and even cigarettes. Homesick: Directed by Matthew Penn. Late clinical signs in larger exposures (1 to 4 hours). Yes, you can overdose on nicotine. Most cases of exposure will be low-risk and management is supportive. Both options are free, confidential and available 24 hours a day, seven days a week. The child couldn't breathe well enough by herself; a breathing tube was placed and attached to a ventilator. If you buy something through links on our site, Babylist may earn a commission. Call the poison control center at 1-800-222-1222. How to prevent poisoning in babies and children, Centers for Disease Control and Prevention: Poisoning. Until recently, nicotine poisoning was rare. www.austin.org.au/poisons, Intentional self harm: Referral to local mental health services e.g. [15] During the same period, the ten most frequent adverse effects to traditional cigarettes reported to US poison control centers were vomiting (80.0%), nausea (9.2%), drowsiness (7.8%), cough (7.2%), agitation (6.6%), pallor (3.0%), tachycardia (2.5%), diaphoresis (1.5%), dizziness (1.5%), and diarrhea (1.4%). Initial stimulatory effects occur within minutes and may include agitation, diaphoresis, nausea and vomiting, tachycardia, bronchoconstriction and seizures. [28] Two children, one in the US in 2014 and another in Israel in 2013, died after ingesting liquid nicotine.[29]. Nicotine is a drug that is considered to have negative side effects on babies similar to illegal drug use during pregnancy, notes Science Daily. [1] Historically, most cases of nicotine poisoning have been the result of use of nicotine as an insecticide. Lead poisoning is a concern if your home was built before 1980. (https://www.healthychildren.org/English/safety-prevention/at-home/Pages/Liquid-Nicotine-Used-in-E-Cigarettes-Can-Kill-Children.aspx), (https://www.poison.org/articles/electronic-cigarettes), (https://aapcc.org/prevention/tobacco-liquid-nicotine). [15], E-cigarette exposure cases in the US National Poison Data System increased greatly between 2010 and 2014, peaking at 3,742 in 2014, fell in 2015 though 2017, and then between 2017 and 2018 e-cigarette exposure cases increased from 2,320 to 2,901. The behavior of a newborn exposed to nicotine is similar to the behavior of a newborn exposed to illicit drugs such as cocaine. Liquid nicotine and e-cigarettes are more likely to lead to nicotine poisoning compared to traditional tobacco-containing products, such as cigarettes and cigars. Let us help you find the right products to help you quit smoking. If so, Poison Control will tell you what to look out for. This is because the nicotine is purer. Updated November 18, 2019. "These results show that even limited secondhand smoke exposure delivers enough nicotine to the brain to alter its function," said NIDA Director Nora D. Volkow, M.D. Make sure you dont leave out any containers with tobacco or nicotine residue on them. Too much nicotine can lead to toxicity. Dont use a stove or fireplace that is not vented to the outside. Nicotine poisoning usually happens in two stages. Duke University Health System. Even in small quantities, carbon monoxide can cause permanent neurologic damage or death. Alcohol: A Dangerous Poison for Children (The Poison Post). Nicotine poisoning can occur in two stages: early phase and late phase. Altered brain development can also affect the center of the brain that regulates bodily organs such as the lungs and heart. Severe poisoning can be life-threatening and lead to seizures. This is about 19% of all adults 18 years or older. Call poison control. Nicotine dependence occurs when you need nicotine and can't stop using it. Immediately remove any contaminated clothing, being careful to limit your own contact. When ingested, the charcoal binds with the nicotine and exits the body without further absorption in the blood. 2005). There are many everyday substances that, even in small amounts, can result in serious injury or death. National Institutes of Health. People who work with nicotine-based products, such as in tobacco plants and harvesting fields, are also possibly at risk. Nicotine primarily affects the heart and central nervous system, regardless of the amount you use. Poison Control and the emergencyroom will stay in touch until your child is out of danger. The nicotine had also caused the child to produce excess secretions which were making it hard to breathe. Medication was administered to dry her secretions. Treatment for nicotine poisoning depends on the severity and amount of exposure. Children are much more prone to nicotine overdose because of their smaller body size. Nicotine poisoning is the result of having too much nicotine in your body. The freshest in parenting this week, delivered to your inbox. [21], It is unlikely that a person would overdose on nicotine through smoking alone. Managing Withdrawal. The minimum potentially lethal dose is reported to be anything greater than 0.5 mg/kg. Poisoning from illicit substances can cause serious health consequences, including changes in alertness and . Smoking and Tobacco Use: Fact Sheets [Internet]. Phase 2 is a later period of depressor effects. [15] 95% of traditional cigarette calls were related to children 5 years old or less. Activated charcoal is very rarely indicated. Nicotine is highly toxic and rapidly absorbed after either ingestion or inhalation. Death can occur within one hour after severe exposure. Call 911 to request an ambulance. . Nicotine withdrawal is the set of physical symptoms that are. Mother. Nicotine is highly addictive and can affect the developing brain, potentially harming teens and young adults. Treatments may include: You can help prevent nicotine poisoning by: If you or your child has been exposed to liquid nicotine, call the Poison Center hotline at 800-222-1222 or call 911. More than half of February calls involved young children. Normal GCS A young British au pair is suspected of poisoning the baby in her care. It can happen if a child ingests medications found in the home, or if a parent accidentally gives a child more than the correct dosage. Brown also notes that these babies are difficult to console and may be stiff or rigid when held. Be sure to check battery-operated toys to ensure that batteries are secure (especially button batteries), and be mindful to store all batteries out of reach. [4], The prognosis is typically good when medical care is provided and patients adequately treated are unlikely to have any long-term sequelae. A dose of 1 g/kg may be recommended in high-risk cases who present early. Baby Center explains that babies who are born too early often have immature lungs that cannot handle breathing on their own and may require medical assistance for the first few days or even weeks of the babys life. "Chronic or severe exposure could result in even higher brain nicotine levels, which may explain why secondhand smoke exposure increases vulnerability to nicotine addiction." 9.2.2 Inhalation Smoking causes coronary and peripheral vascular disease . This can lead to disturbances in breathing, heart rate and temperature and lower blood sugars, which can cause seizures, coma and death.