Cardiac arrest and rapid progression of severe hypoxic-ischemic encephalopathy following ingestion of liquid nicotine.

As the use of electronic cigarettes is increasing, intentional or accidental intoxication following ingestion of the nicotine refill solution has been reported. However, cardiac arrest and severe hypoxic-ischemic encephalopathy following the ingestion of the liquid nicotine are extremely rare. We report a case of cardiac arrest and rapid progression of severe hypoxic-ischemic encephalopathy involving the brainstem following the intentional ingestion of a liquid nicotine. The patient was found to be in respiratory distress and decreased consciousness after ingesting three bottles (30 mL per bottle, nicotine 0.99 %, 10 mg/mL), of e-cigarette liquid nicotine. She was in cardiac arrest when the emergency medical service arrived on scene, so they started cardiopulmonary resuscitation and transported her to the emergency department, where she went into cardiac arrest and ROSC three times during transport. Electrocardiogram on arrival at the emergency department was pulseless electrical activity with ROSC after 1 min of advanced cardiac life support. A brain computed tomography taken after recovery of spontaneous circulation showed no abnormal findings. Despite aggressive post-cardiac arrest care, brain magnetic resonance imaging on the second day after hospitalization and subsequent computed tomography showed severe hypoxic-ischemic encephalopathy with brain stem involvement consistent with severe anoxic brain injury. The patient was deemed brain dead and the patient died on the seventh day of hospitalization. Our case shows the potential for fatal complications of cerebral circulation caused by ingestion of a liquid nicotine.