A new challenge: suicide attempt using nicotine fillings for electronic cigarettes

Introduction:
This letter to the editors describes a case report of a suicide attempt using nicotine fillings for electronic cigarettes. The text also provides a pharmacological evaluation of the patient's serum concentrations of nicotine and its metabolite cotinine. Readers will learn about the potential dangers of e-cigarette refill solutions, the symptoms of nicotine intoxication, and the management of nicotine poisoning.

Key Points:

* The patient, a 27-year-old man with a borderline personality disorder, ingested five e-liquid fillings containing a total of 420 mg of nicotine in a suicide attempt.
* The patient developed mild toxicity, as confirmed by measured nicotine and cotinine serum concentrations.
* Nicotine is readily absorbed through all routes of exposure and has a high degree of first-pass metabolism.
* Acute nicotine intoxication follows a biphasic pattern, with symptoms ranging from vomiting and tachycardia to hypotension, bradycardia, and respiratory failure.
* The information on the concentration of e-liquids reported by the manufacturers is often not accurate.
* Measurement of serum levels of nicotine can be useful in estimating the severity of nicotine intoxication.
* Management of nicotine intoxication consists of general supportive measures and repeated administration of activated charcoal.

Main Message:
This case report highlights the potential dangers of e-cigarette refill solutions and the need for medical professionals to be aware of the symptoms of nicotine intoxication. The patient's serum concentrations of nicotine and cotinine confirm the potential lethality of nicotine, but the fact that the patient developed only mild toxicity suggests that the internationally accepted lethal limit of 60 mg may be too low. The study emphasizes the importance of measuring serum levels of nicotine in cases of suspected nicotine intoxication and the need for further research on the lethal dose of nicotine in humans.

Schipper, Eleonora M., Laura C. G. De Graaff, Birgit C. P. Koch, Zina Brkic, Erik B. Wilms, Jelmer Alsma, and Stephanie C. E. Schuit. “A New Challenge: Suicide Attempt Using Nicotine Fillings for Electronic Cigarettes.” British Journal of Clinical Pharmacology 78, no. 6 (December 2014): 1469–71. https://doi.org/10.1111/bcp.12495.