Search
Electronic cigarettes have been gaining popularity in the U.S. as a smokeless delivery system for nicotine. These devices require liquid nicotine (e-liquid) that are vaporized and inhaled (vaping).
E-liquid can have nicotine concentration as high as 100 mg/mL, which are diluted prior to use. When ingested in high concentration and in sufficient volume (1 vial = 15 mL) patients can develop significant nicotinic toxicity. Recently a case of cardiac arrest has been reported after ingesting two 15 ml vial (100 mg/mL).
Nicotine mimics the effects of acetylcholine (Ach) release by binding to nicotinic receptors located in:
- Brain
- Spinal cord
- Autonomic ganglia
- Adrenal medulla
- Neuromuscular junction
- Chemoreceptors of carotid/aortic bodies
Clinical manifestation of toxicity (similar to cholinergic toxidrome) is biphasic with early central stimulation followed by depression. (see table below)
|
| GI | Respiratory | Cardiovascular | Neurologic |
| Early (1 hr) | Nausea Vomiting Salivation Abdominal pain | Bronchorrhea Hyperpnea | Hypertension Tachycardia Pallor | Agitation Anxiety Dizziness Blurred vision Headache Hyperactivity Tremors Fasciculation Seizures |
| Late (0.5-4 hr) | Diarrhea | Hypoventilation Apnea | Bradycardia Hypotension Dysrhythmias Shock | Lethargy Weakness Paralysis |
Management: There is no specific antidote or reversal agent. The management of nicotine toxicity focuses on organ-specific dysfunction.
References
- Chen BC et al. Death following intentional ingestion of e-liquid. Clin Toxicol 2015;53:914-916.
- Kim JW et al. Liquid nicotine toxicity. Pediatr Emer Care 2015;31:517-524.