Death from Ingestion of E-Liquid

Morley, Stephen; Slaughter, John S.; Smith, Paul

doi:10.1016/j.jemermed.2017.06.029

Cited by 16 publications

(16 citation statements)

References 9 publications

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“…Case reports of nicotine poisonings gave a new insight in the metabolism, bioavailability and the dose/effect relationship of the substance [19,151], adding to the existing controversies regarding the level of fatal nicotine concentrations. The fatal dose of 60 mg indicated by Lazutka et al in 1969 [215] was based on studies in mice, while more recent studies suggest an oral lethal dose of 0.5-1 gr [216].…”

Section: Poisoningsmentioning

confidence: 99%

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Tzortzi

Kapetanstrataki

Evangelopoulou

et al. 2020

IJERPH

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Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016–2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

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Section: Poisoningsmentioning

confidence: 99%

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Tzortzi

Kapetanstrataki

Evangelopoulou

et al. 2020

IJERPH

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“…advocated for a strong, rather than conditional, recommendation. They were concerned about the safety and effectiveness of electronic cigarettes because of reports that were not included in the evidence synthesis (97)(98)(99)(100)(101)(102)(103)(104)(105)(106)(107)(108)(109). They cited reports of deaths or disability due to electronic cigarette-or vaping-associated lung injury (110)(111)(112)(113), burns due to product explosion, acute nicotine poisoning, and seizures, as well as histopathologic injuries in laboratory studies.…”

Section: American Thoracic Society Documentsmentioning

confidence: 99%

NewsCAP: New guidelines favor varenicline for smoking cessation.

2020

AJN, American Journal of Nursing

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Background: Current tobacco treatment guidelines have established the efficacy of available interventions, but they do not provide detailed guidance for common implementation questions frequently faced in the clinic. An evidence-based guideline was created that addresses several pharmacotherapy-initiation questions that routinely confront treatment teams. Methods: Individuals with diverse expertise related to smoking cessation were empaneled to prioritize questions and outcomes important to clinicians. An evidence-synthesis team conducted systematic reviews, which informed recommendations to answer the questions. The GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach was used to rate the certainty in the estimated effects and the strength of recommendations. Results: The guideline panel formulated five strong recommendations and two conditional recommendations regarding pharmacotherapy choices. Strong recommendations include using varenicline rather than a nicotine patch, using varenicline rather than bupropion, using varenicline rather than a nicotine patch in adults with a comorbid psychiatric condition, initiating varenicline in adults even if they are unready to quit, and using controller therapy for an extended treatment duration greater than 12 weeks. Conditional recommendations include combining a nicotine patch with varenicline rather than using varenicline alone and using varenicline rather than electronic cigarettes. Conclusions: Seven recommendations are provided, which represent simple practice changes that are likely to increase the effectiveness of tobacco-dependence pharmacotherapy.

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“…The popularity of electronic cigarettes (e-cigarette) has increased since its commercialisation in 2004 [1]. Despite being considered safer than conventional nicotine delivery systems [2, 3], the number of reported intoxications has significantly increased worldwide [4, 5].…”

Section: Introductionmentioning

confidence: 99%

“…Despite being considered safer than conventional nicotine delivery systems [2, 3], the number of reported intoxications has significantly increased worldwide [4, 5]. In Europe, The European Tobacco Product Directive (TPD) reported 277 incidents in 10 countries between 2012 to 2015 [6] while 1414 cases were registered in 2013 in the United States [1] alone. While the majority of cases are not serious, 6,3% have more severe outcomes [6], sometimes fatal [1, 3].…”

Section: Introductionmentioning

confidence: 99%

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Near fatal intoxication by nicotine and propylene glycol injection: a case report of an e-liquid poisoning

Belkoniene¹,

Socquet²,

Njemba-Freiburghaus³

et al. 2019

BMC Pharmacol Toxicol

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Background Concern about intoxication by e-liquid is growing as calls to poison control centers have increased since their introduction. Only three cases of intoxication by injection have been reported worldwide. Our case is unique because of the precise follow-up of a patient who survived a lethal dose of self-injected e-liquid, without other co-intoxication. Case presentation A 51-year-old male presented to the Emergency Department after injecting himself intravenously (IV) in the forearm with 10 mL of e-liquid (1000 mg of nicotine diluted in propylene glycol). An agitation phase was followed by coma and bradypnoea requiring mechanical ventilation. The patient developed a transitory neurological impairment with the appearance of tetraparesis, gaze palsy and myoclonus due to nicotinic syndrome. The arterial blood gas (ABG) analysis confirmed uncompensated lactic acidosis with an elevated anion gap, which is an expected effect of propylene glycol. The toxicology screen indicated the presence of nicotine and cotinine in the blood and excluded the presence of concomitant intoxication. The patient recovered without sequelae. Conclusion Even a small quantity of intravenous (IV) e-liquid can lead to an acute intoxication and fatal outcomes due to the toxic effects of nicotine. This case might help emergency doctors cope with acute intoxication by injection of e-liquid and increase their comprehension of the two main substances, nicotine and propylene glycol with overview of their pharmacodynamics and kinetic effects.

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Death from Ingestion of E-Liquid

Cited by 16 publications

References 9 publications

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

NewsCAP: New guidelines favor varenicline for smoking cessation.

Near fatal intoxication by nicotine and propylene glycol injection: a case report of an e-liquid poisoning

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