Nicotine Toxicity Secondary to Aftermarket Modifications to a Vaping Device

Area of Science:

• Toxicology
• Public Health
• Emergency Medicine

Background:

• Electronic cigarettes (e-cigarettes) are increasingly popular, marketed as a safer alternative to traditional smoking.
• Vaping use is prevalent among young adults, including active duty military personnel.
• Concerns exist regarding e-cigarette or vaping product use-associated lung injury (EVALI).

Purpose of the Study:

• To report cases of nicotine toxicity resulting from modified e-cigarette devices.
• To raise awareness about the potential for high nicotine concentrations in modified vaping products.
• To highlight a previously unrecognized risk associated with e-cigarette modification.

Main Methods:

• Case report of two active duty patients presenting with symptoms of toxicity.
• Clinical evaluation in an emergency department setting.
• Review of e-cigarette usage patterns and device modifications.

Main Results:

• Both patients exhibited clinical signs and symptoms consistent with nicotine toxicity.
• The toxicity was linked to the use of heavily modified e-cigarette devices designed for higher nicotine delivery.
• This represents a novel route of nicotine overdose via customized vaping technology.

Conclusions:

• Heavily modified e-cigarettes can deliver dangerously high nicotine concentrations.
• Nicotine toxicity is an emerging risk associated with e-cigarette use, distinct from lung injury.
• Healthcare providers should consider modified vaping devices in cases of suspected nicotine toxicity, especially in young populations.