• Journal of The Korean Society of Clinical Toxicology
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• v.20 no.2
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• pp.82-85
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• 2022

Traditionally, most cases of nicotine poisoning have been due to ingestion of nicotine pesticides. However, the increasing use of electronic cigarettes (e-cigarettes) has resulted in both intentional and unintentional exposure to concentrated liquid nicotine or "e-liquid" leading to an increase in nicotine poisoning cases. However, fatalities following the ingestion of the e-liquid are extremely rare. We report a rare case of cardiac arrest and severe encephalopathy following the intentional ingestion of e-liquid. We present the case of a 20-year-old woman who intentionally ingested liquid nicotine intended for e-cigarette use. She was found in asystole and experienced a return of spontaneous circulation (ROSC) after undergoing approximately 46 mins of cardiopulmonary resuscitation. Her plasma nicotine levels were >500 ng/ml. Despite aggressive supportive care, she was found to have encephalopathy consistent with severe anoxic brain injury on magnetic resonance imaging. In recent times, there have been some reports of deaths following liquid nicotine ingestion. Our case illustrates the potential for fatal nicotine toxicity from ingestion of e-cigarettes.

• Analytical Science and Technology
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• v.36 no.1
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• pp.22-31
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• 2023

As the use of e-liquid cigarettes is rapidly increasing worldwide, it multiplies the potential risk undisclosed to the health of non- and smokers. To reduce the hazard, each country has its own set of regulations for controlling e-liquids. In Korea, the narrow definition of tobacco makes it difficult and have been steadily occurring tax evasion exploiting the difference in natural and artificial nicotine. Therefore, it is very important to distinguish source of nicotine for their regulation. To find biochemical discriminant markers, this study established analysis methods based on high-performance liquid chromatography coupled with diode array detector (HPLC-DAD) and high-performance liquid chromatography coupled with triple Quadrupole mass spectrometry (HPLC-MS/MS) for nicotine enantiomers and tobacco alkaloids targeted using the difference in pathways of nicotine biosynthesis and chemical synthesis. The method was validated by experimenting linearity (R² > 0.999), recovery (80.99-108.41 %), accuracy (94.11-109.73 %) and precision (0.04-8.27 %). Then, the results for discrimination of the nicotine obtained from analysis of 65 commercial e-liquid products available in Korean market was evaluated. The method successfully applied to the e-liquids and one sample labelled 'synthetic nicotine' for tax exemption was found to contain a natural nicotine product. This method can be used to determine whether an e-liquid product uses natural or artificial nicotine and monitor non-taxable e-liquid products. The method is more scientific than the existing one, which relies only on field evidence.

• Journal of The Korean Society of Clinical Toxicology
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• v.16 no.2
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• pp.172-175
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• 2018

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.

• Clinical and Experimental Pediatrics
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• v.59 no.12
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• pp.490-493
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• 2016

Electronic cigarettes are novel tobacco products that are frequently used these days. The cartridge contains liquid nicotine and accidental poisoning, even with a small oral dose, endangers children. We present here a mortality case of a 15-month-old child who ingested liquid nicotine mistaking it for cold medicine. When the emergency medical technicians arrived, she was found to have pulseless electrical activity. Spontaneous circulation was restored after approximately 40 minutes of cardiopulmonary resuscitation. The cotinine level in her urine was 1,716 ng/mL. Despite intensive supportive care, severe anoxic brain injury was found on computed tomography and the child ultimately died. This fatality highlights the need for public health efforts to minimize such accidents.

• Analytical Science and Technology
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• v.34 no.4
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• pp.180-190
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• 2021

This study compared the efficacy of chiral GC and chiral HPLC for the analysis of nicotine. To develop a suitable dispersive liquid-liquid microextraction (DLLME) method, the following parameters were optimized: pH, extraction solvent, dispersive solvent, type and quantity of salt, and laboratory temperature. The validation of the method was carried out by the established HPLC method. The LODs were 0.11 ㎍/mL and 0.17 ㎍/mL for the (S)- and (R)- enantiomers, respectively. The LOQs were 0.30 ㎍/mL and 0.44 ㎍/mL, respectively. The optimal calibration range was between 0.30-18 ㎍/mL and 0.44-4.40 ㎍/mL, respectively, and the correlation coefficient (r²) was 0.9978-0.9996. The intra-day accuracy was 79.9-110.6 %, and the intra-day precision was 1.3-12.0 %. The inter-day accuracy was 87.8-108.0 %, and the inter-day precision was 4.0-12.8 %. E-liquid and biological fluids (urine and saliva) were analyzed using the established method.

• Journal of The Korean Society of Clinical Toxicology
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• v.18 no.2
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• pp.51-56
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• 2020

Purpose: Acute nicotine poisoning by liquid nicotine in electronic cigarettes is becoming an increasing problem worldwide. The current systematic review aimed to determine the harm of acute nicotine poisoning by reviewing published case reports. Methods: An online literature search with PubMed, Embase, Cochrane Library, and KoreaMed database was performed to identify relevant studies addressing acute nicotine poisoning with electronic cigarettes. Two investigators searched the case reports written in English or Korean. Results: Twenty-six cases were included in this study. The routes of intoxication included ingestion in 18 cases, intravenous injection in three cases, subcutaneous injection in two cases, and ocular exposure in two cases. Ten cases had a cardiac arrest, and seven of them died. Seven out of 12 cases with intentional poisoning had a cardiac arrest. Nine children under 18 years were reported, and three of them had a cardiac arrest. Sixteen cases without a cardiac arrest recovered well, except for one case with sudden sensorineural hearing loss. Conclusion: The authors reviewed the risks of electronic cigarette liquid in terms of acute poisoning through a systematic review. The nicotine solution of an e-cigarette can be life-threatening in cases of acute poisoning. Therefore, active emergency treatment with early recognition is necessary. In addition, various management methods and regulations for preventing acute nicotine poisoning, such as restriction of distribution and nicotine concentration, should be considered.

• Journal of Plant Biology
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• v.34 no.2
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• pp.101-106
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• 1991

Effects of two auxins, 2,4-dichlorophenoxyacetic acid (2,4-D) and a-napthaleneacetic acid (NAA) on nicotine production during callus culture of a wild tobacco (Nicotiana glauca) were investigated using a high performance liquid chromatography (HPLC). The high concentration ($11.5\;\mu\textrm{M}$)of 2,4-D and NAA had peaks of nicotine contents at 4th and 2nd week, respectively. Thereafter, the concents decreased and the nicotine was metabolized to other alkaloids. The low concentration ($1.5\;\mu\textrm{M}$) of 2,4-D on the medium supplemented with 0.1 mM of L-aspartic acid or L-arginine inhibited nicotine production. However, the low NAA promoted it only when the medium was supplemented with L-aspartic acid. From these results, it could be concluded that both auxins exhibit different action mechanisms on nicotine production pathway and the low NAA promotes the activities for the pathway with L-aspartic acid as a precursor.cursor.

• Journal of The Korean Society of Clinical Toxicology
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• v.15 no.1
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• pp.60-64
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• 2017

Nicotine-poisoning related to the electronic cigarettes (e-cigarette) is increasing worldwide. Moreover, the American Association of Poison Control Centers has advised the public to use caution with e-cigarette devices and highly concentrated liquid nicotine after a surge in related poisonings. We report here the first case of nicotine poisoning from self-injected e-cigarette fluid in Korea. A 17-year-old male patient subcutaneously injected himself with 0.5 ml of nicotine solution for an electronic cigarette via the dorsum of his hand, after which he complained of nausea, vomiting, dizziness and dyspnea. His vital signs were within the normal range, but his mental status was drowsy. He was admitted for observation and the symptoms disappeared the following day. Sinus bradycardia with a rate of 45/min was observed on the third hospital day, but improved after 6 hours. He was discharged without complications.

• Current Optics and Photonics
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• v.4 no.4
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• pp.368-372
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• 2020

We report the terahertz time-domain spectroscopy (THz-TDS) of transdermal drug delivery in human skin. The time evolution of transdermal nicotine delivery in nicotine patches was assessed by detecting the transmission coefficient of sub-picosecond THz pulses and using a semi-analytic model based on the single-layer effective medium approximation. Using commercial nicotine patches (Nicoderm CQ^®, 7 mg/24 h), THz transmission coefficients were measured to quantitatively analyze the cumulative amounts of nicotine released from the patches in the absence of their detailed specifications, including multilayer structures and optical properties at THz frequencies. The results agreed well with measurements by conventional in vitro and in vivo methods, using a diffusion cell with high-performance liquid chromatography and blood sampling respectively. Our study revealed the ability of the THz-TDS method to be an effective alternative to existing methods for noninvasive and label-free assessments of transdermal drug delivery, showing its high promise for biomedical, pharmaceutical, and cosmetic applications.

• Journal of Environmental Health Sciences
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• v.39 no.6
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• pp.483-491
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• 2013

Objectives: Electronic cigarettes are battery powered devices that convert a nicotine-containing liquid into an inhalable vapor. The device aerosolizes nicotine so that it is readily entrained into the respiratory tract, from where it enters the bloodstream. Information on the safety of E-cigarettes is required. Methods: Seventeen articles on studies analyzing toxic substances in the liquid and gas phases of electronic cigarettes were reviewed. Results: Tobacco-specific nitrosamines, bis(2-ethylhexyl) phthalate, formaldehyde and acetaldehyde, known to be carcinogenic agents in humans or animals, were detected in the liquid and gas phases. In addition, diethyl phthalate, acetone, ethanol, cresol, xylene, propylene, styrene, triethylene glycol, tetraethylene glycol, pentaethylene glycol cis-3-hexen-1-ol, methyl cinnamate and undecane were identified in the liquid and gas phases of E-cigarettes. Propylene glycol, glycerin, 1-methoxy-2-propanol, 1-hydroxy-2- propanone, acetic acid, 1-menthone, 2,3-butanediol, menthol, carvone, maple lactone, benzyl alcohol, 2-methyl-2-pentanoic acid, ethyl mantel, ethyl cinnamate, myosamine, benzoic acid, 2,3-bipyridine, cotinine, hexadecanoic acid, and 1'1-oxybis-2-propanol were detected in the vapors of E-cigarettes. Conclusion: The hazardous compounds identified in the liquid and gas phases of E-cigarettes should be controlled for the lowest concentrations in the raw materials and production procedures.