People who vape or use nicotine sometimes end up in the emergency department unsure whether they’re having nicotine poisoning or a panic attack. The symptoms can overlap in frustrating ways: racing heart, dizziness, nausea, a sense that something terrible is about to happen. I’ve seen teenagers come in after ripping a high-nicotine disposable, convinced they were dying. I’ve also seen long-time smokers who quit vaping abruptly develop surges of anxiety that mimic a medical crisis. Sorting out the difference matters, because the next steps are not the same for each scenario.
This guide walks through how nicotine poisoning and panic attacks feel, what signs tip the balance toward one or the other, when to seek help, and how to keep it from happening again. It also touches on the bigger picture: vaping health risks, what we’ve learned about EVALI and popcorn lung claims, and how to find practical, real-world support if you want to quit vaping.
How nicotine acts on your body, and why too much goes sideways
Nicotine is a stimulant that binds to nicotinic acetylcholine receptors in the brain and throughout the body. In small to moderate doses it increases alertness and attention, bumps heart rate, and releases dopamine. That quick lift is part of why it hooks people.
In high doses, the story flips. Nicotine stimulates and then desensitizes those receptors. The result can look like a rollercoaster: first a surge of nausea, sweating, and palpitations, then weakness or dizziness. With very high exposure, vomiting is common because the body tries to throw out the poison. People can develop tremors, headache, pallor, abdominal cramping, diarrhea, and in severe cases confusion or seizures. The timing often relates to the exposure. If someone chain-vapes a high-strength liquid or swallows nicotine pouches, symptoms tend to appear within minutes to an hour.
Vaping complicates this because modern devices can deliver nicotine fast. A typical disposable with 5 percent nicotine salts can contain nicotine equivalent to a pack of cigarettes or more. One 20-minute stress session can unknowingly push your dose into the toxic zone. I’ve heard versions of the same story from college students during finals: switched from a lower-nicotine pod to a 50 mg/mL disposable, took long pulls back-to-back, then 15 minutes later the room started to spin and their stomach flipped.
What a panic attack really feels like
A panic attack is a sudden surge of intense fear that peaks within minutes. Your body behaves as if you’re in physical danger: adrenaline kicks up, breathing becomes fast and shallow, heart rate climbs, and your mind scans for threats. Many people feel chest tightness or sharp chest pain, lightheadedness, tingling in the hands or around the mouth, chills or hot flashes, and a sense of unreality. A classic thought spirals in: “I’m going to die,” or “I’m losing control.”
Nicotine can provoke this cascade, especially in people prone to anxiety. Stimulants prime the nervous system. If you vape frequently, your baseline arousal runs higher, sleep often runs lighter, and caffeine piles on top. Quit abruptly and withdrawal can add irritability, restlessness, and anxious surges. That’s part of the trap of vaping addiction: the device becomes both the relief and the trigger.
The overlap with nicotine poisoning is obvious in the moment. Both can involve palpitations, sweating, tremor, and nausea. The distinction often shows up in patterns, progression, and objective signs like vomiting or diarrhea in poisoning versus hyperventilation and an intense fear of dying in panic.
Practical ways to tell them apart in the moment
People want a simple rule. Unfortunately, bodies don’t follow scripts. What helps is a short mental triage, grounded in what you just did and how your symptoms behave over time.
- Ask what changed in the last hour. Did you use more nicotine than usual, switch to a stronger e-liquid, double up with pouches and a vape, or accidentally swallow e-liquid? A clear exposure spike leans toward nicotine poisoning. Note the first symptom. Nausea with drooling or vomiting appearing early, especially with pallor and abdominal cramps, points to nicotine poisoning. A sudden wave of fear or doom with chest tightness and rapid breathing, without early vomiting, points to panic. Watch the gut. Profuse vomiting and diarrhea are much more common in nicotine poisoning. In panic, the stomach can feel upset, but repeated vomiting is less typical. Check your breathing pattern. Hyperventilation and tingling around the mouth or in the fingers often reflect a panic attack. Nicotine poisoning can cause breathing changes, but the tingling pattern from over-breathing is a clue. Track the arc. Panic attacks usually peak within 10 to 20 minutes and begin to fade with slow breathing and grounding. Nicotine poisoning may fluctuate but can persist longer, especially if you keep dosing or swallowed nicotine.
These are heuristics, not absolutes. Chest pain, severe shortness of breath, confusion, and fainting are danger signs regardless of the cause. If those show up, get medical care.
What mild, moderate, and severe nicotine poisoning looks like
Mild nicotine toxicity can show up after a heavy vaping session as queasiness, headache, dizziness, sweating, salivation, and a racing heart. Many people notice they feel weak and want to lie down. The body often self-corrects within a few hours as nicotine levels fall, provided you stop exposure and hydrate. That said, if you’re repeatedly hitting this zone, your use is likely higher than you realize.
Moderate poisoning adds repeated vomiting, abdominal cramps, diarrhea, blurred vision, and tremor. People can look pale and clammy. Attempting to vape again during this phase worsens symptoms. Oral nicotine swallowed accidentally, like e-liquid that leaked into the mouth, is a common trigger.
Severe poisoning is a medical emergency. It can include confusion, seizures, sustained low blood pressure after an initial spike, and in rare cases life-threatening heart rhythm problems. This scenario is more likely in small children who ingest e-liquids or in adults with massive exposures, such as concentrated nicotine base used for DIY mixing. Vaping alone rarely produces severe toxicity in otherwise healthy adults, but risk climbs with high-concentration products, rapid back-to-back use, and mixing nicotine with other stimulants.
If a child or pet may have ingested nicotine, treat it as urgent and seek help immediately. Nicotine is far more dangerous per kilogram in small bodies.
Panic attacks: fast, scary, and exhausting
Panic attacks can feel indistinguishable from a heart event, especially the first time. People report chest pain that stabs or aches, shortness of breath, a sense they can’t get a full breath, and a feeling of impending doom. If hyperventilation persists, fingers can cramp and lips tingle due to shifts in carbon dioxide.
Unlike nicotine poisoning, vomiting is less prominent. Panic tends to respond to targeted calming techniques: slow diaphragmatic breathing, grounding through the senses, and muscle relaxation. It also eases when the triggering thought loop is interrupted. The brain’s alarm slows when it realizes the tiger isn’t real.
Here is a quick, field-tested sequence I have coached patients through in exam rooms and waiting areas:
- Breathe in through the nose for four seconds, hold for two, out through pursed lips for six. The slow exhale is the key. Repeat ten cycles. Name five things you see, four you feel, three you hear, two you smell, one you taste. This anchors the mind in the present. Unclench your jaw and drop your shoulders. Relaxed posture feeds back safety signals.
If a panic attack is driven by repeated nicotine spikes or withdrawal, these methods still help in the moment, but you will keep fighting fires until the nicotine pattern changes.
The role of vaping devices and liquids
Modern vapes have shifted the nicotine landscape. Nicotine salts, which dominate the market, are less harsh on the throat at high concentrations. That lets manufacturers pack more nicotine into each puff without making it feel unpleasant. The upshot: people can take far larger doses before the body’s natural “stop” signals kick in.
Disposable vapes sold in some regions claim 5 percent nicotine, but unit size varies widely. A small “600 puff” device is not the same as a 5,000 puff behemoth with multiple milliliters of liquid. Labels can be inconsistent, and counterfeit devices bypass any quality control. I’ve seen users assume a new brand matched their usual, only to learn the hard way that it delivered much more nicotine.
Add in flavorings and cooling agents that mask harshness, and the risk of overuse climbs. Pair this with a stressful day, minimal food, and caffeine, and you have prime conditions for nausea, palpitations, and shakiness.
If you’ve had a scare, one practical move is to step down both strength and device output. Choose lower mg/mL liquids, avoid high-power devices, and prevent teen vaping incidents measure actual consumption. The goal is to eliminate surprise overdoses while you figure out a plan to stop vaping altogether.
Vaping health risks, beyond nicotine
People often discover the difference between nicotine poisoning and panic attacks during a crisis, then step back and ask the larger question: what is vaping doing to my lungs and body?
The respiratory effects of vaping vary by product and pattern of use. Short-term, many users report throat irritation, cough, and chest tightness, especially with high-propylene glycol liquids or menthol and cooling flavors. Asthma symptoms can worsen. Repeated deep inhalation of aerosols can provoke bronchial hyperreactivity. Over months to years, studies have linked regular vaping to increased odds of chronic bronchitis symptoms, wheeze, and reductions in measures of small-airway function. The long-term arc is still being quantified, but the signal is not benign.
A few clarifications help cut through confusion:
- Popcorn lung vaping. The term comes from bronchiolitis obliterans cases in workers exposed to high diacetyl levels in popcorn factories. Many e-liquids removed diacetyl after early alarms, but not all products worldwide are well regulated. Testing has found diacetyl and related compounds in some flavors. The exact risk from typical consumer exposure remains debated, yet the prudent stance is to avoid inhaling flavoring chemicals not meant for the lungs. EVALI symptoms. The 2019 outbreak of e-cigarette or vaping product use-associated lung injury (EVALI) was linked primarily to vitamin E acetate used as a thickener in illicit THC vapes. Symptoms included shortness of breath, chest pain, cough, fever, gastrointestinal upset, and low oxygen levels. Most cases were not from nicotine-only products. Still, the episode underscored a key lesson: when supply chains go gray or black market, lung injury risks spike. Cardiovascular strain. Nicotine elevates heart rate and blood pressure. Vaping can acutely stiffen arteries and affect endothelial function. For people with underlying heart disease, those short spikes matter.
Given this backdrop, incidents of nicotine poisoning or panic are often turning points. They expose how thin the margin can be between “just a habit” and feeling unwell.
When you should seek medical care
Trust your instincts. If you feel unsafe, get help. There are a few clear triggers for professional evaluation:
- Severe or persistent chest pain, fainting, confusion, seizure, or severe shortness of breath. Repeated vomiting that prevents hydration, especially after suspected nicotine overdose. A child or pet exposed to nicotine e-liquid, pouches, or concentrated mix. New neurological symptoms like weakness on one side, slurred speech, or vision loss.
If symptoms are milder but you’re unsure, many regions have poison control hotlines staffed by toxicology experts. They can help you triage nicotine poisoning risk based on product strength and the amount used. If you present to urgent care or an emergency department, bring the device or liquid if safe to do so. Labels and nicotine concentration matter.
For panic attacks that recur, schedule time with your primary care clinician or a mental health professional. Occasional panic is common. Frequent, debilitating episodes deserve care and a plan.
What to do at home during a suspected nicotine overdose
If nicotine poisoning seems likely, stop all nicotine immediately. Sip water or an oral rehydration solution. Do not induce vomiting. If vomiting is ongoing, small sips every few minutes may stay down better than gulps. Rest in a quiet place. Avoid caffeine or other stimulants for the rest of the day.
Most mild cases improve over several hours as nicotine levels fall. If you used a high-strength product or swallowed liquid, or your symptoms escalate, seek medical help. The goal is supportive care and prevention of complications like dehydration.
One overlooked point: after a rough episode, some people try to “steady” themselves with another vape because they feel edgy or shaky. That backfires. The edginess is part of the overdose hangover. More nicotine prolongs it.
What to do during a panic surge
If the pattern points toward panic, create a brief script that you can follow without thinking. You can keep it on your phone:
- Breathe: inhale 4 seconds, hold 2, exhale 6, repeat ten times. Longer exhales slow the heart. Ground: name five things you see, four you feel, three you hear, two you smell, one you taste. Move: walk slowly or stretch, releasing muscle tension.
If you’ve recently increased nicotine use or caffeine, or you’re withdrawing after trying to quit vaping, note that pattern. You are not doing anything wrong. Your nervous system is adapting, and it will settle with a structured plan.
The deeper fix: unwinding nicotine dependence
If you’ve had even one scare, consider it valuable feedback. The device is running you. The safest dose is zero, and the best protection against repeat episodes is to quit vaping.
People succeed when they use structure rather than willpower alone. Here’s a straightforward approach that fits busy lives and avoids perfection traps.
- Pick a quit date within the next two weeks. Short timelines focus the mind. Choose a nicotine replacement regimen that actually covers your baseline. Patches deliver steady background; gum, lozenges, or an inhaler handle surges. Many adults underdose. If you’re on 20 to 50 mg/mL vapes, a 21 mg patch plus gum or lozenges for cravings is a reasonable starting point. Adjust with your clinician’s guidance. Remove frictionless access. Toss or lock away disposables, pods, and liquids. Wipe nicotine residue off hands and desks. If supplies live in the car or nightstand, your plan will bleed time and motivation. Map your high-risk windows. Morning coffee, driving, gaming, after meals, stress breaks. Decide a replacement for each: gum for the drive, a short walk after meals, a squeeze ball while gaming. Expect withdrawal peaks at 3 days and 2 weeks. Sleep can dip. Mood can swing. These are signs of healing.
For people with heavier dependencies or a history of anxiety, prescription options can tip the odds. Varenicline reduces the reward of nicotine and craving intensity. Bupropion helps with mood and withdrawal. Both can be paired with patches or lozenges. Discuss risks, benefits, and timing with your clinician.
Motivation matters, but momentum matters more. A single day off nicotine resets your belief. Stack a week, then two. If you slip, learn from exactly when and why. Tweak the plan and keep going. The research is clear: most former smokers and vapers made multiple serious attempts before it stuck.
Addressing the fear of weight gain and stress
Two practical worries often derail attempts to stop vaping. The first is weight. Nicotine slightly suppresses appetite and revs metabolism. When you quit, hunger can jump. Anticipate it with protein-rich snacks, a water bottle within reach, and low-effort meals you actually like. Build a short daily walk into the plan. This isn’t about a perfect diet, it’s about not being surprised.
The second worry is stress. Many users feel vaping is their only break. Reframe the break, not the chemical. Two minutes of slow breathing resets your physiology better than a nicotine hit. A call to a friend, a quick stretch, a glass of cold water, a lap outside the building, a to-do list reset, even 10 wall push-ups will discharge tension without the rebound.
What about harm reduction instead of zero?
Not everyone is ready to quit vaping immediately. Some want to cut down or switch products. Harm reduction can be a bridge. If you vaping epidemic solutions go this route, set measurable changes and timelines so it doesn’t become a stall.
Dropping nicotine levels in your e-liquid, moving from disposables to refillable low-power devices, and setting hard caps on daily puffs can reduce spikes and the risk of nicotine poisoning. Spacing puffs and avoiding chain vaping cut peak levels. Avoid stacking nicotine products, like pouches plus a vape in the same hour. Replace late-night vaping with a no-nicotine routine to protect sleep.
Harm reduction is not risk-free. It can still perpetuate the cycle of anxiety and relief. If your episodes of panic or nausea continue, treat that as feedback to move toward a full quit.
Vaping epidemic realities and the teen risk window
Among adolescents, the vaping epidemic didn’t happen by accident. Flavors, sleek designs, and high-nicotine salts created a fast path to dependence. Teens often take bigger hits without appreciating dose. We see a mix of issues in clinics: chest tightness on exertion, chronic cough, anxiety spikes that mimic nicotine poisoning, and sleep problems worsened by late-night vaping.
Parents and caregivers do better when they stay curious rather than punitive. Ask what brand, what strength, how often. Offer concrete help: a nicotine patch, a check-in plan, a ride to counseling. Scare tactics tend to backfire, but accurate information about vaping side effects and school sports performance can land. If a teen has a scare with palpitations or vomiting, act on it. Early treatment for vaping addiction works best before the patterns harden.
When medical help becomes part of the plan
If you’ve decided to stop vaping and feel wobbly on your own, this is the moment to bring in professionals. A primary care clinician can tailor nicotine replacement, prescribe varenicline or bupropion, and screen for anxiety or depression that often ride along. Behavioral therapists can teach cognitive techniques to dismantle panic loops and break the cue-reward pairing with the vape. Many communities have programs specifically for vaping addiction treatment, including digital coaching that fits into daily life.
If you’ve had an episode suggestive of nicotine poisoning, mention it explicitly. Details guide advice: brand, nicotine strength, number of puffs, whether you swallowed liquid, what symptoms came first, how long they lasted. If you’ve had EVALI-like symptoms such as persistent shortness of breath, cough, fever, or low oxygen, seek care sooner rather than later. While EVALI was largely tied to illicit THC products, clinicians still evaluate nicotine users for other respiratory issues, including asthma exacerbations and possible vaping lung damage over time.
A few steady truths to carry forward
Most people who experience a frightening event tied to nicotine wish they could roll back the clock a day. The next best thing is turning that event into a pivot. The line between nicotine poisoning and a panic attack can be blurry in the moment, but the long game is the same. Reduce exposure, relearn calm without a stimulant, and give your lungs and nervous system room to normalize.
If you need a single sentence to come back to: nothing bad happens when nicotine levels quietly fall. Your body is built to steady itself once the chemical stops pushing.
The door out is open. It takes a month of imperfect practice, not superhuman discipline. If you want help, ask for it. If you want to go alone, keep your plan simple, prepare for the hard spots at day 3 and week 2, and treat every slip as data. Your heart, lungs, sleep, and mood will thank you.
And if, later tonight, you feel that familiar flutter in your chest and your mind starts to race, pause. Put the vape down. Breathe in for four, hold for two, out for six. Repeat. Drink some water. Step outside. The feeling will pass. Then keep going.