A new challenge: suicide attempt using nicotine fillings for electronic cigarettes

Noortje Schipper, Laura de Graaff, Birgit Koch, Zana Brkic, EB (Erik) Wilms, Jelmer Alsma, Stephanie Schuit

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Recently, a previously healthy 27-year-old man with a borderline personality disorder presented at our emergency department 1 h after ingestion of five e-liquid fillings in an suicide attempt. He had also consumed five units of wine. The e-liquid fillings contained a total of 420 mg of nicotine and unknown amounts of propyleneglycol and glycerine (Figure 1). Before arrival at the emergency department, the patient had vomited three times, but upon arrival he was free of complaints. The patient denied ingestion of other substances (aside from the reported ethanol). The paramedics found no other empty containers in the patient's house, nor were there any drugs visible in the vomitus. The serum concentration of acetaminophen was also not detectable (<2.8 mg l−1). Initial evaluation showed a sinus tachycardia of 117 beats min−1, a blood pressure of 144/99 mmHg and normal oxygen saturation at 98%. Besides sinus tachycardia, the electrocardiogram showed no abnormalities. The patient was afebrile (36.1°C). Apart from excessive salivation, physical examination was unremarkable. Laboratory examination revealed a high anion gap [16 mmol l−1 (normal, 8–12 mmol l−1)] lactic acidosis with a pH of 7.33 and lactic acid of 3.8 mmol l−1. The osmolality gap was 30 mOsm kg−1 H2O (normally <10 mOsm kg−1 H2O) and ethanol 3.9‰. Activated charcoal was administered and repeated twice (because of enterohepatic circulation of nicotine). According to the literature 7, we advised a 24 h observation period. During the actual observational period of 30 h, no adverse events occurred, and the metabolic acidosis disappeared within 10 h after admission. The patient was discharged after psychiatric consultation.
Original languageEnglish
Pages (from-to)1469-1471
Number of pages3
JournalBritish Journal of Clinical Pharmacology
Issue number6
Publication statusPublished - 2014

Research programs

  • EMC MUSC-01-48-01
  • EMC OR-01-34-01


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