Last month, the Annals of Emergency Medicine reported on the toxic effects to a six-year-old child who accidentally swallowed liquid nicotine. The child ingested the product intended for her parents' electronic cigarettes and required immediate emergency medical treatment that included intubation and an overnight stay in a pediatric intensive care unit. The unique case was reported just a couple of weeks after the U.S. Surgeon General's report calling the dangers of e-cigarettes a "major public health concern."
"Liquid nicotine is highly concentrated, which makes it especially dangerous in households with children," said lead study author Matthew Noble, MD, of the Department of Emergency Medicine at Oregon Health and Science University, Portland. "In this instance, the girl lost consciousness nearly immediately after drinking the liquid nicotine and despite prompt action by her parents and emergency medical services, she still required mechanical ventilation and admission to the intensive care unit. Fortunately, she was ultimately discharged from the hospital in stable condition, but under slightly different circumstances could have suffered a tragic outcome."
The patient's mother had filled an empty ibuprofen bottle with liquid nicotine she mixed herself, using a combination of unflavored nicotine she purchased online and vegetable glycerin. The child's father, not realizing the ibuprofen bottle contained his wife's nicotine, administered a dose to his daughter for pain associated with a sprained ankle. The effects were immediate and the father contacted poison control and 9-1-1 within 5 minutes. Even after she regained consciousness, she had altered mental status, her heart rate dropped, and she developed vomiting, profuse sweating, muscle twitching, and inability to control her copious secretions.
The authors said maximum commercial liquid nicotine concentrations are currently neither well established nor well regulated, and some consumers have advocated increasing nicotine concentrations in electronic cigarettes to more closely approximate nicotine delivery from conventional tobacco cigarettes.
"As electronic cigarette use proliferates, children are now increasingly at risk of toxicity from ingestions of much larger quantities of nicotine from highly concentrated refill liquid, as in our case study," said Noble. "We expect that emergency physicians and poison centers will continue to encounter clinical significant cases of nicotine toxicity, especially in pediatric patients."