Journal of The Korean Society of Clinical Toxicology (대한임상독성학회지)

Korean society of Clincal Toxicology (대한임상독성학회)
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A Case Report of Cardiac Arrest Following Intentional Ingestion of Liquid Nicotine for Electronic Cigarette

전자담배용 니코틴 원액 음독 후 발생한 심정지 1례

  • Kim, Jung Ho (Department of Emergency Medicine, Yeungnam University College of Medicine)
  • 김정호 (영남대학교 의과대학 응급의학교실)
  • Received : 2018.07.01
  • Accepted : 2018.07.28
  • Published : 2018.12.31
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Abstract

Acute nicotine poisoning by liquid nicotine for electronic cigarettes is becoming an increasing problem worldwide. On the other hand, there are no regulations regarding its concentration, container or labelling in Korea. This is the first case of a cardiac arrest after liquid nicotine ingestion that was confirmed by plasma nicotine detection in Korea. A 34-year-old male was found with a cardiac arrest at home by the emergency medical services crew, and had a return of spontaneous circulation after 27 minutes of cardio-pulmonary resuscitation. The cause of his cardiac arrest was suspected to be acute nicotine poisoning by the ingestion of liquid nicotine. Toxicology analysis of the National Forensic Service confirmed plasma nicotine, and the pharmacokinetic estimated average concentration of plasma nicotine at the time of the cardiac arrest was 29.7 mg/L, a lethal dose. He was hospitalized for further treatment, but was discharged after 20 days without any improvement. Considering the strong toxicity of nicotine, appropriate policy decisions are required for sales and distribution.

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References

  1. Protano C, Manigrasso M, Avino P, Sernia S, Vitali M. Secondhand smoke exposure generated by new electronic devices (IQOS(R) and e-cigs) and traditional cigarettes: submicron particle behaviour in human respiratory system. Ann Ig 2016;28:109-12.
  2. Kennedy RD, Awopegba A, De Leon E, Cohen JE. Global approaches to regulating electronic cigarettes. Tob Control 2017;26:440-5. https://doi.org/10.1136/tobaccocontrol-2016-053179
  3. Raymond BH, Collette-Merrill K, Harrison RG, Jarvis S, Rasmussen RJ. The Nicotine Content of a Sample of Ecigarette Liquid Manufactured in the United States. J Addict Med 2018;12:127-31. https://doi.org/10.1097/ADM.0000000000000376
  4. Ordonez JE, Kleinschmidt KC, Forrester MB. Electronic cigarette exposures reported to Texas poison centers. Nicotine Tob Res 2015;17:209-11. https://doi.org/10.1093/ntr/ntu223
  5. Kim S, Goniewicz ML, Yu S, Kim B, Gupta R. Variations in label information and nicotine levels in electronic cigarette refill liquids in South Korea: regulation challenges. Int J Environ Res Public Health 2015;12:4859-68. https://doi.org/10.3390/ijerph120504859
  6. Chen BC, Bright SB, Trivedi AR, Valento M. Death following intentional ingestion of e-liquid. Clin Toxicol (Phila) 2015;53:914-6. https://doi.org/10.3109/15563650.2015.1090579
  7. Kamboj A, Spiller HA, Casavant MJ, Chounthirath T, Smith GA. Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States. Pediatrics 2016;137.
  8. Choi J, Ko DR, You JS, Chung SP. A case report of acute nicotine poisoning from subcutaneous injection of nicotine solution for electronic cigarette. J Korean Soc Clin Toxicol 2017;6:60-4.
  9. Park EJ, Min YG. The Emerging Method of Suicide by Electronic Cigarette Liquid: a Case Report. J Korean Med Sci 2018;33:e52. https://doi.org/10.3346/jkms.2018.33.e52
  10. Sommerfeld K, Lukasik-Glebocka M, Kulza M, Druzdz A, Panienski P, Florek E et al. Intravenous and oral suicidal e-liquid poisonings with confirmed nicotine and cotinine concentrations. Forensic Sci Int 2016;262:e15-20. https://doi.org/10.1016/j.forsciint.2016.03.005
  11. Maina G, Castagnoli C, Passini V, Crosera M, Adami G, Mauro M et al. Transdermal nicotine absorption handling e-cigarette refill liquids. Regul Toxicol Pharmacol 2016;74:31-3. https://doi.org/10.1016/j.yrtph.2015.11.014
  12. Lardi C, Vogt S, Pollak S, Thierauf A. Complex suicide with homemade nicotine patches. Forensic Sci Int 2014;236:e14-8. https://doi.org/10.1016/j.forsciint.2013.12.017
  13. Morley S, Slaughter J, Smith PR. Death from Ingestion of E-Liquid. J Emerg Med 2017;53:862-4. https://doi.org/10.1016/j.jemermed.2017.06.029
  14. Kim JW, Baum CR. Liquid Nicotine Toxicity. Pediatr Emerg Care 2015;31:517-21. https://doi.org/10.1097/PEC.0000000000000486