Department of Internal Medicine, Hôpital Neuchâtelois, Neuchâtel, Switzerland.
Intensive Care Unit, Hôpital Neuchâtelois, Neuchâtel, Switzerland.
BMC Pharmacol Toxicol. 2019 May 10;20(1):28. doi: 10.1186/s40360-019-0296-8.
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.
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.
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.
自电子烟问世以来，因吸入电子烟液体而中毒的案例逐渐增多，这一问题引发了人们的关注。全球范围内仅有三起因注射电子烟液体而中毒的报告。我们报告的病例十分独特，因为我们对一名患者进行了精确的跟踪，该患者在注射致死剂量的电子烟液体后幸存下来，且未发生其他共同中毒。
一名 51 岁男性将 10 毫升电子烟液体（丙二醇中稀释的 1000 毫克尼古丁）自行静脉注射（IV）到前臂后，到急诊科就诊。患者先经历了激动期，然后陷入昏迷和呼吸过缓，需要进行机械通气。患者出现了短暂的神经功能障碍，表现为四肢瘫痪、眼球运动障碍和肌阵挛，这是尼古丁综合征的表现。动脉血气（ABG）分析证实存在未代偿性乳酸酸中毒和阴离子间隙升高，这是丙二醇的预期作用。毒理学检测显示血液中存在尼古丁和可替宁，排除了同时存在其他中毒的可能性。患者最终恢复，无后遗症。
即使是少量的静脉内（IV）电子烟液体也可能导致尼古丁的毒性作用引起急性中毒和致命后果。本病例可能有助于急诊医生应对因注射电子烟液体引起的急性中毒，并提高他们对尼古丁和丙二醇这两种主要物质的理解，包括它们的药代动力学和动力学效应的概述。
