Not only smoking is deadly: fatal ingestion of e-juice—a case report

Abstract

A fatal case of nicotine intoxication by oral intake of a nicotine solution, sold via the Internet, is reported. The concentrated nicotine solution (72 mg/mL) is usually diluted with polypropylene, polyethylene glycol or glycerine, respectively, in order to allow the user to generate their own solution for vaporisation in electronic cigarettes (e-juice). A 34-year-old man was found lifeless by his parents, who reported that their son had been in good health and had shown no hints of suicidal behaviour. The medicolegal autopsy revealed unspecific findings. Toxicological analysis revealed nicotine concentrations of 5.5 mg/L in femoral venous blood, 136 mg/L in heart blood, 12.0 mg/kg in brain tissue, 42.6 mg/kg in kidney tissue, 89.5 mg/kg in lung tissue and a total amount of 3,950 mg in the gastric contents. Cotinine concentrations were 0.9 mg/L in femoral venous blood, 7.6 mg/L in heart blood, 0.4 mg/kg in brain tissue, 0.9 mg/kg in kidney tissue and 0.8 mg/kg in lung tissue. No cotinine was detected in the gastric contents. The nicotine level measured in the femoral blood was in good accordance with the levels reported in other fatal cases caused by oral or patch application of nicotine. Moreover, the high level of nicotine in lung and kidney tissue, compared to that within femoral blood, strikingly emphasises the strong effect of post-mortem redistribution, underlined by the comparably low concentration of nicotine in the brain. The extremely high level of nicotine in the heart blood is more likely due to the high concentration in the gastric contents, due to oral intake, and by accumulation of the basic substance in the acidic gastric contents. This further highlights the effect of post-mortem redistribution. The mother of the deceased later admitted that her son had been suffering from psychosis and that she found a package containing five nicotine solution vials of the brand "Titanium Ice" (of 50 mL each). Three of the vials were empty. The nicotine concentration in the e-juice Titanium Ice was confirmed by HPLC analysis.

Electronic cigarettes: what are they and what do they do?

“…254,255,[257][258][259] Emergency department case reports presented similar findings with children, and also called for increased public education, including among physicians, as well as regulatory efforts to curtail these occurrences. 260,261 There have also been reports of the use of ECIG liquids in suicide attempts 263 with at least two fatalities, one by oral administration of a liquid containing 72 mg/mL nicotine 264 and the other by intravenous injection of an unspecified product. 262 The Center for Tobacco Products at the FDA has also fielded complaints regarding adverse events related to ECIG use, some of which have been severe, including pneumonia, congestive heart failure, and burns to the face from device explosions.…”

Mass spectrometric fragmentation and photocatalytic transformation of nicotine and cotinine

“…The refilling solutions for ENDS (e‐juices) are available as solutions of nicotine in propylene glycol, glycerol and water at high concentration, up to 35 mg/mL. These solutions are highly toxic and if ingested can be fatal . Furthermore, nicotine and its biological metabolite cotinine are ubiquitous contaminants that could also be effectively used for monitoring tobacco consumption by wastewater and river water analysis .…”

“…These solutions are highly toxic [1] and if ingested can be fatal. [2] Furthermore, nicotine and its biological metabolite cotinine are ubiquitous contaminants [3] that could also be effectively used for monitoring tobacco consumption by wastewater and river water analysis. [4] Therefore, different smoking habits [5] and the use and the cross abuse of drugs and tobacco [6] were studied by wastewater analysis targeted on nicotine metabolism.…”

Patients with lung cancer: Are electronic cigarettes harmful or useful?

“…Among children one fatal case has been reported with a high concentrate of nicotine use to prepare do-it-yourself e-liquid [12] and non-fatal cases have been reported also with e-liquid in children [13][14]. Nicotine liquids have been used in adult suicide attempts: [15][16], one attempt failed with 1500 mg [17] but another succeeded with 10 000 mg (equivalent of 50 tanks of high concentration e-liquid [18]. All e-liquid bottle caps need to be child resistant.…”