title: Death following intentional ingestion of e-liquid.
abstract: BACKGROUND
  Electronic cigarette (e-cigarette) use is growing within the United States, resulting in both intentional and unintentional exposures to concentrated liquid nicotine or "e-liquid." Nicotine has been culpable for severe poisoning and deaths in the past. However, sources of nicotine have traditionally been from cigarettes, cigars, or pesticides. Fatalities due to liquid nicotine are rare, and fatalities following ingestion of e-liquid are even scarcer.
  
  
  METHODS
  We present a case of a 24-year-old woman who intentionally ingested up to 3000 mg of liquid nicotine intended for e-cigarette use. She was found in pulseless electrical activity and had return of spontaneous circulation (ROSC) after undergoing approximately 10 min of cardiopulmonary resuscitation with a blood pressure of 74/53 mmHg and a pulse rate of 106 beats/min. Despite aggressive supportive care, she ultimately died after she was found to have multiple acute infarcts, consistent with severe anoxic brain injury, on magnetic resonance imaging. The patient's toxicologic testing, obtained shortly after ROSC, was notable for plasma nicotine and cotinine levels each >1000 ng/mL.
  
  
  CONCLUSIONS
  This fatality highlights the potential toxicity associated with suicidal ingestion of liquid nicotine.
authors.affiliation: a Division of Emergency Medicine , Harborview Medical Center, University of Washington School of Medicine, Washington Poison Center , Seattle , WA , USA.
authors.forename: Betty C
authors.initials: BC
authors.lastname: Chen
authors.affiliation: a Division of Emergency Medicine , Harborview Medical Center, University of Washington School of Medicine, Washington Poison Center , Seattle , WA , USA.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Bright
authors.affiliation: a Division of Emergency Medicine , Harborview Medical Center, University of Washington School of Medicine, Washington Poison Center , Seattle , WA , USA.
authors.forename: Amit Raj
authors.initials: AR
authors.lastname: Trivedi
authors.affiliation: a Division of Emergency Medicine , Harborview Medical Center, University of Washington School of Medicine, Washington Poison Center , Seattle , WA , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Valento
mesh_terms: D015415:Biomarkers / Q000097:blood; D003367:Cotinine / Q000097:blood; D066300:Electronic Nicotine Delivery Systems / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D006439:Hemodynamics / Q000187:drug effects; D006801:Humans; D009538:Nicotine / Q000097:blood / Q000506:poisoning*; D018722:Nicotinic Agonists / Q000097:blood / Q000506:poisoning*; D011041:Poisoning / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D012307:Risk Factors; D013405:Suicide; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D018722:Nicotinic Agonists; D009538:Nicotine; D003367:Cotinine
keywords: E-cigarettes; E-liquid; Liquid nicotine; Public health