E-liquid can have nicotine concentration as high as 100 mg/mL, which are diluted prior to use. When ingested in high concentration and in sufficient volume (1 vial = 15 mL) patients can develop significant nicotinic toxicity. Recently a case of cardiac arrest has been reported after ingesting two 15 ml vial (100 mg/mL).
Clinical manifestation of toxicity (similar to cholinergic toxidrome) is biphasic with early central stimulation followed by depression. Can involve GI (N&V, diarrhea), cardio (hypertension, tachycardia –> bradycardia), respiratory (bronchorrhea, tachypnea –> apnea), CNS (agitation, seizure –> somnolence, coma) etc.
No specific antidote. based on organ specific dysfunction eg cholinergic toxidromes = atropine, seizure = BZ
Chen BC et al. Death following intentional ingestion of e-liquid. Clin Toxicol 2015;53:914-916.
Kim JW et al. Liquid nicotine toxicity. Pediatr Emer Care 2015;31:517-524