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November 23, 1994

Nicotine Scores Again: In-Hospital Withdrawal

JAMA. 1994;272(20):1576-1577. doi:10.1001/jama.1994.03520200032025

To the Editor.  —Nicotine addiction is the most common of all substance dependencies, incurring enormous medical, social, and psychological costs. Recent technological advances, such as the advent of transdermal nicotine patches, have broadened the strategies for nicotine replacement in highly dependent smokers and may aid in cigarette smoking cessation.1 Herein we describe a patient in whom the high dependence on nicotine almost resulted in a fatal catastrophe.A 36-year-old man with a medical history of Alport's disease, cadaveric renal transplant a year prior to admission, and longstanding nicotine dependency was admitted to a smoke-free hospital with acute cholecystitis. Having been treated with intravenous antibiotics and hydration, the patient then underwent an uneventful cholecystectomy. After the operation, he was given 2 L of oxygen per minute via a nasal cannula. A day later, the patient was irritable, anxious, and restless, and he requested permission to smoke cigarettes. His request was