First case report of toxicity from ingestion of e-cigarette nicotine liquid

May 7, 2014, 7:47 pm


Nicotine Poisoning in an Infant. Bassett RA et al. N Engl J Med 2014 May 7 [Epub before print]

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This short “letter to the editor” is, to my knowledge, the first reported case of toxicity from ingestion of e-cigarette nicotine liquid. A 10-month-old male ingested an unknown amount of nicotine-containing liquid compounded at a local “vape” shop. The liquid was labelled as containing 1.8% nicotine (18 mg/ml) as well as glycerin, propylene glycol, and oil of wintergreen (methyl salicylate). the child presented with vomiting, tachycardia, “grunting” respirations, and truncal ataxia. Symptoms resolved by 6 hours after ingestion without specific treatment. The serum salicylate level was “normal.”

If, as reported in some sources, the lethal dose of nicotine can be as low as 1 mg/kg, a milliliter or tw0 might be enough to cause fatality in a toddler. As this letter points out, a recent re-evaluation of the evidence suggests that the actual deadly dose is much higher. The authors brief discussion in this letter makes the following points:

  • At this point e-cigarette nicotine liquids are completely unregulated, and may contain dangerous unlisted ingredients such as oil of wintergreen. (Recently the FDA has announced plans to begin regulation of the industry.)
  • An e-cigarette liquid labelled, say, “16 mg” contains 16 mg of nicotine per milliliter, not 16 mg in the entire vial.
  • Ingestion of low-dose nicotine often presents with tachycardia and vomiting.
  • Significant central nervous system toxicity can include ataxia and seizures.
  • At higher doses, specificity for the nicotinic cholinergic receptors can be lost and manifestations of muscarinic toxicity (e.g., increased secretions) can supervene.
  • Exposure to large amounts of nicotine can cause muscle weakness, respiratory paralysis, and death.

Severe toxicity from e-cigarette nicotine liquid has not yet been reported. Since nicotine is an irritant, it is unlikely a child would willingly ingest enough of a dose to be life-threatening. However, in preparation for a column on the subject, I recently taste-tested a number of these products. Although some were unpalatable, a few of the coffee and fruit-flavored formulations were surprisingly tasty.

HT @Rx_Ed

Related posts:

Calls to poison centers related to nicotine-containing e-cigarette liquid skyrocketing

E-cigarettes: risk of nicotine toxicity

Pediatric nicotine ingestions


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