A suicide case of liquid nicotine intoxication

Area of Science:

• Forensic Toxicology
• Cardiovascular Pathology
• Public Health

Background:

• A man in his 50s presented with vomiting and altered mental status, subsequently experiencing cardiopulmonary arrest.
• Previous suicide attempt and discovery of e-cigarette nicotine liquid bottles prompted police investigation into unnatural death.

Purpose of the Study:

• To determine the cause of death in a case involving suspected nicotine intoxication from e-cigarette use.
• To investigate the role of high-concentration nicotine exposure in a fatal outcome.

Main Methods:

• Forensic autopsy including examination of organs and cardiovascular system.
• Comprehensive drug screening using liquid chromatography-tandem mass spectrometry (LC-MS/MS) on biological samples.
• Quantitative analysis of nicotine and cotinine levels in blood, urine, and stomach contents.

Main Results:

• Autopsy revealed obesity and abundant fat deposits, but no significant cardiovascular abnormalities.
• LC-MS/MS detected aripiprazole, nicotine, and cotinine.
• High concentrations of nicotine were found in all samples, with femoral venous blood levels exceeding the lethal dose.

Conclusions:

• Nicotine intoxication, likely from e-cigarette liquid, was determined as the cause of death, leading to arrhythmia or respiratory failure.
• The case underscores the potential dangers of readily available high-concentration nicotine from e-cigarettes.
• Forensic evaluations must consider nicotine addiction risks, especially with increasing e-cigarette use.