Lactic acidosis due to voluntary e-liquid ingestion

Introduction:
This text is a case report of a patient who experienced acute poisoning after voluntarily ingesting e-liquid, a solution used in electronic cigarettes. The report highlights the clinical and biological consequences of this poisoning, with a focus on the role of propylene glycol in the patient's symptoms.

Key points:

* The patient deliberately ingested 30 ml of e-liquid and presented to the emergency department with symptoms including headache, nausea, abdominal pain, tachypnea, and muscular paralysis.
* Toxicological investigations found the presence of nicotine, cotinine, and propylene glycol in the patient's blood and urine.
* The patient's symptoms were consistent with propylene glycol intoxication, rather than nicotine poisoning.
* Propylene glycol intoxication can cause an ion and/or osmolar gap with or without lactic acidosis.
* The patient's blood concentration of propylene glycol was 300 mg/L, which is below the threshold for toxic effects.
* The patient also experienced severe rhabdomyolysis and hypokalemia, which were likely due to circulatory and metabolic disturbances.
* Clinicians should be aware of the potential for propylene glycol poisoning in cases of e-liquid ingestion and consider toxicological investigations for propylene glycol when a patient presents with a metabolic acidosis and high anion and/or osmolal gaps.

Main message:
This case report highlights the importance of considering propylene glycol poisoning in cases of e-liquid ingestion, as the symptoms may be mistaken for nicotine poisoning. Clinicians should be aware of the potential for propylene glycol poisoning and consider toxicological investigations for propylene glycol when evaluating patients with metabolic acidosis and high anion and/or osmolal gaps. It is crucial for regulatory agencies to consider the potential toxicity of solvents used in electronic nicotine delivery systems, as not only nicotine but also solvents can pose a risk to users.

Garat, Anne, Patrick Nisse, Marie Kauv, Monique Mathieu-Nolf, Delphine Allorge, and Daniel Mathieu. “Lactic Acidosis Due to Voluntary E-Liquid Ingestion.” Toxicologie Analytique et Clinique 28, no. 4 (December 2016): 329–32. https://doi.org/10.1016/j.toxac.2016.05.001.