Nicotine withdrawal, like alcohol withdrawal, may present as an unexplained problems in a hospitalized patient. Not everyone will admit to nicotine use.
Clinical features:
(1) history of current heavy nicotine use
(2) onset of acute symptoms in the hospital which may include:
(2a) acute delirium
(2b) agitation and restlessness resistant to sedation
(3) reversal of symptoms by application of a transdermal nicotine patch
The admission urine can be screened for nicotine metabolites if the diagnosis is in question.
Since people who smoke often drink, a patient with nicotine withdrawal may also show alcohol withdrawal, and vice versa.
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