Death following intentional ingestion of e-liquid

Clin Toxicol (Phila). 2015 Nov;53(9):914-6. doi: 10.3109/15563650.2015.1090579. Epub 2015 Oct 12.

Abstract

Context: Electronic cigarette (e-cigarette) use is growing within the United States, resulting in both intentional and unintentional exposures to concentrated liquid nicotine or "e-liquid." Nicotine has been culpable for severe poisoning and deaths in the past. However, sources of nicotine have traditionally been from cigarettes, cigars, or pesticides. Fatalities due to liquid nicotine are rare, and fatalities following ingestion of e-liquid are even scarcer.

Case: We present a case of a 24-year-old woman who intentionally ingested up to 3000 mg of liquid nicotine intended for e-cigarette use. She was found in pulseless electrical activity and had return of spontaneous circulation (ROSC) after undergoing approximately 10 min of cardiopulmonary resuscitation with a blood pressure of 74/53 mmHg and a pulse rate of 106 beats/min. Despite aggressive supportive care, she ultimately died after she was found to have multiple acute infarcts, consistent with severe anoxic brain injury, on magnetic resonance imaging. The patient's toxicologic testing, obtained shortly after ROSC, was notable for plasma nicotine and cotinine levels each >1000 ng/mL.

Discussion: This fatality highlights the potential toxicity associated with suicidal ingestion of liquid nicotine.

Keywords: E-cigarettes; E-liquid; Liquid nicotine; Public health.

Publication types

  • Case Reports

MeSH terms

  • Biomarkers / blood
  • Cotinine / blood
  • Electronic Nicotine Delivery Systems / adverse effects*
  • Fatal Outcome
  • Female
  • Heart Arrest / blood
  • Heart Arrest / chemically induced*
  • Heart Arrest / diagnosis
  • Heart Arrest / physiopathology
  • Heart Arrest / therapy
  • Hemodynamics / drug effects
  • Humans
  • Nicotine / blood
  • Nicotine / poisoning*
  • Nicotinic Agonists / blood
  • Nicotinic Agonists / poisoning*
  • Poisoning / diagnosis
  • Poisoning / physiopathology
  • Poisoning / therapy
  • Risk Factors
  • Suicide*
  • Treatment Outcome
  • Young Adult

Substances

  • Biomarkers
  • Nicotinic Agonists
  • Nicotine
  • Cotinine