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Near fatal intoxication by nicotine and propylene glycol injection: a case report of an e-liquid poisoning.
BMC Pharmacology and Toxicology ( IF 2.605 ) Pub Date : 2019-05-10 , DOI: 10.1186/s40360-019-0296-8
Mhedi Belkoniene 1 , Jennifer Socquet 1 , Denise Njemba-Freiburghaus 2 , Cyril Pellaton 1
Affiliation  

BACKGROUND 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. CASE PRESENTATION 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. CONCLUSION 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.

中文翻译:

尼古丁和丙二醇注射液几乎致命的中毒:一例电子液体中毒的报道。

背景技术自从引入中毒控制中心以来,对电子液体中毒的关注日益增加。全世界仅报道了三例注射中毒的病例。我们的病例之所以如此独特,是因为该患者经过精确的随访,该患者在致死剂量的自我注射电子液体中幸存下来,而没有其他共中毒。病例介绍一名51岁的男性在前臂静脉内(IV)注射了10毫升电子液体(1000毫克尼古丁在丙二醇中稀释)后,出现在急诊科。搅动阶段后是昏迷和缓慢呼吸,需要机械通气。该患者因烟碱综合症而出现四肢轻瘫,凝视麻痹和肌阵挛,出现短暂的神经系统损害。动脉血气(ABG)分析证实了未补偿的乳酸性酸中毒,阴离子间隙增加,这是丙二醇的预期作用。毒理学筛查表明血液中存在尼古丁和可替宁,并排除了中毒的发生。病人康复无后遗症。结论由于尼古丁的毒性作用,即使少量的静脉内(IV)电子液体也会导致急性中毒和致命的后果。这种情况可能有助于急诊医生通过注射电子液体来应对急性中毒,并通过对它们的药效学和动力学作用的概述来提高对尼古丁和丙二醇这两种主要物质的理解。毒理学筛查表明血液中存在尼古丁和可替宁,并排除了中毒的发生。病人康复无后遗症。结论由于尼古丁的毒性作用,即使少量的静脉(IV)电子液体也会导致急性中毒和致命的后果。这种情况可能有助于急诊医生通过注射电子液体来应对急性中毒,并通过对它们的药效学和动力学作用的概述来提高对尼古丁和丙二醇这两种主要物质的理解。毒理学筛查表明血液中存在尼古丁和可替宁,并排除了中毒的发生。病人康复无后遗症。结论由于尼古丁的毒性作用,即使少量的静脉(IV)电子液体也会导致急性中毒和致命的后果。这种情况可能有助于急诊医生通过注射电子液体来应对急性中毒,并通过对它们的药效学和动力学作用的概述来提高对尼古丁和丙二醇这两种主要物质的理解。结论由于尼古丁的毒性作用,即使少量的静脉(IV)电子液体也会导致急性中毒和致命的后果。这种情况可能有助于急诊医生通过注射电子液体来应对急性中毒,并通过对它们的药效学和动力学作用的概述来提高对尼古丁和丙二醇这两种主要物质的理解。结论由于尼古丁的毒性作用,即使少量的静脉(IV)电子液体也会导致急性中毒和致命的后果。这种情况可能有助于急诊医生通过注射电子液体来应对急性中毒,并通过对它们的药效学和动力学作用的概述来提高对尼古丁和丙二醇这两种主要物质的理解。
更新日期:2019-05-10
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