Severe Neurological Nicotine intoxication by e-cigarette liquids: Systematic Literature Review

Electronic cigarettes are a popular, easily purchased, alternative source of nicotine that is considered safer than conventional tobacco. However, Intentional or accidental exposure to e-liquid substances, mainly nicotine, can lead to serious, potentially fatal toxicity. Emergency and critical care physicians should keep in mind acute intoxication of this poison with a biphasic toxic syndrome. We highlight its potentially fatal outcome and suggest monitoring the adverse effects of nicotine according to a multimodal protocol integrating somatosensory evoked potentials, electroencephalography and neuroimaging data with anamnestic report and toxicological and laboratory data.

Keywords: brain death; cardiac arrest; e-cigarettes; e-liquid; hypoxic ischaemic encephalopathy; intoxication; neurological prognostication; nicotine.