Fatal ingestion of e-cigarette nicotine liquid

January 9, 2018, 1:55 am

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★★½☆☆

Death from Ingestion of E-Liquid. Morley S et al. J Emerg Med 2017 Dec;53:862-864.

Abstract

This short case report is presented in a somewhat confusing fashion but nevertheless brings up interesting points.

A 32-year-old man was brought to hospital after having a cardiac arrest in the field 1 hour after ingesting approximately 20 ml of e-cigarette nicotine liquid containing 72 mg/ml of nicotine (total dose approximately 1440 mg.) He was resuscitated but had developed anoxic encephalopathy and died 3 days later. A plasma nicotine level drawn 24 hours after admission was 1600 ng/ml. His plasma ethanol level on admission was 246 mg/dL.

The authors note that severe nicotine toxicity can present in a biphasic pattern, with initial stimulation (nausea and vomiting, diaphoresis, hypertension tachycardia, tremors, seizures) followed — often within an hour after ingestion — by inhibition and depressive effects such as bradycardia, hypotension, shock, coma.)

Although some references still state that the lethal adult dose of nicotine can be as low as 60 mg, the evidence backing this figure is scant. A more convincing argument claims that the deadly dose is > 500 mg, or > 70 mg in a 10 kg child. It is important to realize that vials claiming to contain, say, 36 mg of nicotine actually contain 36 mg/ml of the poison.

In any event, this patient clearly ingested a lethal dose. The out-of-hospital collapse that led to his developing anoxic brain damage was likely from a combination of the depressive effects of nicotine and ethanol.

To read my Emergency Medicine News column on e-cigarette liquid poisoning — including my tasting notes on flavors such as “Grapeful Dead,” click here. In another column, I describe my personal experience with nicotine toxicity.

Related Posts:

Review: liquid nicotine toxicity

Taste test: would a child find e-cigarette nicotine liquids appealing?

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

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

E-cigarettes: risk of nicotine toxicity

Nicotine liquid fatality — but was it from intravenous injection?

 

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