Honours Program CRU + Bachelor, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Medical Physiology, Division of Heart & Lungs, University Medical Center Utrecht, Utrecht, The Netherlands.
Clin Toxicol (Phila). 2020 Jan;58(1):1-8. doi: 10.1080/15563650.2019.1636994. Epub 2019 Jul 9.
Electronic cigarettes (e-cigarettes), the smokeless alternative to conventional tobacco cigarettes, have become increasingly popular. E-cigarettes vaporise e-liquid, a solution of highly concentrated nicotine, propylene glycol (PG) and vegetable glycerine (VG). With the popularity of e-cigarettes, e-liquid refills have become easily accessible and several cases of intoxication due to the ingestion of e-liquid have been reported. We provide an overview of these cases, their pathophysiology and patients' characteristics. We carried out a retrospective evaluation of the scientific literature reporting on cases of liquid nicotine intoxication, using the following inclusion criteria: (1) the article is or contains a case report, (2) describes an intoxication with e-liquid, (3) the substance contains nicotine, and (4) intake is oral, intravenous or subcutaneous. We found 26 case reports describing a total of 31 patients who suffered from e-liquid intoxication. All intoxications up to the age of six were reported as unintentional, whereas nearly all cases from ages 13 to 53 were due to suicide attempts. The three most prevalent symptoms of e-liquid intoxication were tachycardia, altered mental status and vomiting. Eleven cases resulted in the death of the patient. In the survivors, the highest plasma concentration of nicotine was 800 µg L, while the lowest concentration in the non-survivors was 1600 µg L. There is a mismatch between the generally accepted lethal oral nicotine dose of 60 mg, resulting in approximately 180 µg L plasma concentration, and the 4.4- to 8.9-fold higher lethal plasma concentrations we found in cases of e-liquid intoxication. In these severe intoxications, plasma cotinine concentration does not act as a more reliable indicator of nicotine intoxication than nicotine itself. The ages of the patients display a bimodal distribution. In patients above the age of 10, intoxication results mainly from suicide attempts rather than accidental ingestion. The role of PG and VG in e-liquid intoxications is remarkably unclear. However, the similarity across nicotine and PG toxicity symptoms leads us to believe a cumulative effect cannot be excluded.
电子烟（e-cigarettes）是传统烟草香烟的无烟替代品，越来越受欢迎。电子烟将电子烟液蒸发为蒸汽，电子烟液是一种高浓度尼古丁、丙二醇（PG）和蔬菜甘油（VG）的溶液。随着电子烟的普及，电子烟液的补充剂变得容易获得，并且由于摄入电子烟液而导致中毒的情况也有报道。我们提供了这些病例的概述，包括其病理生理学和患者特征。我们对报告液体尼古丁中毒病例的科学文献进行了回顾性评估，使用了以下纳入标准：（1）文章或包含病例报告，（2）描述了电子烟液中毒，（3）该物质含有尼古丁，（4）摄入途径为口服、静脉或皮下。我们共找到了 26 份病例报告，共描述了 31 名患者发生了电子烟液中毒。截至 6 岁的所有中毒均为非故意的，而年龄在 13 至 53 岁之间的几乎所有中毒都是自杀企图所致。电子烟液中毒的三个最常见症状是心动过速、意识状态改变和呕吐。11 例患者死亡。在幸存者中，最高的尼古丁血浆浓度为 800μg/L，而非幸存者的最低浓度为 1600μg/L。普遍接受的口服致死性尼古丁剂量为 60mg，导致约 180μg/L 血浆浓度，而我们在电子烟液中毒病例中发现的致死性血浆浓度高出 4.4 至 8.9 倍，这两者之间存在不匹配。在这些严重中毒的情况下，血浆可替宁浓度并不能像尼古丁本身一样作为更可靠的尼古丁中毒指标。患者年龄呈双峰分布。在 10 岁以上的患者中，中毒主要是由于自杀企图而不是意外摄入引起的。PG 和 VG 在电子烟液中毒中的作用尚不清楚。然而，尼古丁和 PG 毒性症状的相似性使我们相信不能排除累积效应。
