Summary
Introduction:
This text is a case report of a pediatric patient who ingested a high concentration of liquid nicotine used in electronic cigarettes, resulting in severe toxicity and intubation. The authors aim to alert emergency physicians to this relatively new and emerging exposure and the potential significant clinical effects it may have, as well as the wide variation in actual concentrations of commercial liquid nicotine preparations.
Key Points:
* The patient ingested approximately 703 mg (35 mg/kg) of liquid nicotine, resulting in severe toxicity and intubation.
* Analysis of the ingested liquid suggests a nicotine concentration of 140.6 mg/ml in the purchased commercial product, or 234% of its labeled concentration.
* Liquid nicotine used in electronic cigarettes is highly concentrated, unreliably packaged, and poorly regulated.
* Nicotine is an alkaloid that stimulates the central nervous system and autonomic ganglia through multiple molecular and cellular mechanisms.
* Previous attempts at establishing toxic doses of nicotine have been fraught with difficulty and inconsistency.
* Clinicians should be aware of these products and the potential severity of toxicity they may incur.
* The Food and Drug Administration recently extended its regulatory authority to electronic nicotine delivery systems, including electronic cigarettes and their components, although the extent to which it will limit the available nicotine concentration of electronic nicotine delivery systems remains to be seen.
Main Message:
The text highlights the dangers of unregulated and unreliably packaged liquid nicotine used in electronic cigarettes, especially for pediatric patients. With the increasing popularity and widespread availability of electronic cigarette products, emergency physicians and poison centers can expect to encounter clinically significant cases of nicotine toxicity. The Food and Drug Administration has recently extended its regulatory authority to electronic nicotine delivery systems, but the extent to which it will limit the available nicotine concentration remains to be seen. It is essential for clinicians to be aware of these products and the potential severity of toxicity they may incur.
Citation
Noble, Matthew J., Beck Longstreet, Robert G. Hendrickson, and Roy Gerona. “Unintentional Pediatric Ingestion of Electronic Cigarette Nicotine Refill Liquid Necessitating Intubation.” Annals of Emergency Medicine 69, no. 1 (January 2017): 94–97. https://doi.org/10.1016/j.annemergmed.2016.08.448.
