E-liquid, often called vape juice, is the substance heated by an electronic vaping device to create an aerosol for inhalation. This liquid typically consists of a base mixture of propylene glycol and vegetable glycerin, various flavorings, and, most significantly, nicotine. Ingesting this liquid poses an immediate danger because the nicotine concentration is far higher than what is found in traditional tobacco products. The concentrated form of nicotine acts as a potent neurotoxin, which can be rapidly absorbed through the digestive tract.
The Role of Nicotine and Other Ingredients
The primary component of concern in vape juice is nicotine. Nicotine is an agonist, meaning it binds to and activates nicotinic acetylcholine receptors (nAChRs). At lower doses, this action causes a stimulatory effect, but the high concentrations present in e-liquids can lead to severe overstimulation and subsequent blockade of these receptors, disrupting normal nerve signaling.
Propylene glycol (PG) and vegetable glycerin (VG) make up the bulk of the e-liquid, serving as the carrier solvents. While these compounds are generally recognized as safe for consumption in food and pharmaceuticals, ingesting large quantities can still cause gastrointestinal discomfort. However, PG and VG are not the main toxic threat. That danger rests almost entirely with the nicotine content, which can be absorbed quickly into the bloodstream.
E-liquids also contain various flavorings, which are sometimes associated with irritation of the throat and mouth. Their toxic potential is secondary to the immediate, life-threatening danger posed by concentrated nicotine.
Recognizing Acute Nicotine Poisoning
Symptoms of acute nicotine poisoning progress in two distinct phases, beginning rapidly after ingestion. The initial phase is characterized by a stimulatory response, often appearing within 15 to 60 minutes of swallowing the liquid. Early signs include increased salivation, abdominal cramping, nausea, and often forceful vomiting.
The stimulatory effects also manifest as neurological symptoms like dizziness, mild tremors, and confusion, accompanied by changes in cardiovascular function. An individual may experience an elevated heart rate (tachycardia) and higher blood pressure.
If the dose is large enough, the second, more severe depressive phase can set in. This progression occurs as the nervous system receptors become blocked by the excessive nicotine. Symptoms in this late stage include low blood pressure (hypotension), a slow heart rate (bradycardia), and profound muscle weakness or paralysis. The most dangerous outcomes involve difficulty breathing and respiratory failure, which can lead to seizures, coma, and even death if not immediately treated.
Factors Influencing Toxicity Levels
The danger level following ingestion is highly dependent on the nicotine concentration listed on the e-liquid bottle. Concentrations can range from 3 milligrams per milliliter (mg/mL) to 50 mg/mL or more. This wide variation highlights why the product label is such an important piece of information in an emergency situation.
The total volume of e-liquid swallowed directly determines the overall nicotine dose the body must process. A larger volume of a concentrated product translates into a much faster onset of severe systemic toxicity. Even a small amount of liquid nicotine can be extremely hazardous due to its high concentration.
Body weight and age are significant factors that determine vulnerability to nicotine poisoning. Children and infants are exponentially more susceptible because their smaller body mass means that even minimal amounts of nicotine constitute a dangerously high dose per kilogram of weight. Any ingestion in a child should be treated as an immediate medical emergency.
Immediate Emergency Procedures
After any suspected ingestion of vape juice, call for professional medical help immediately. In the United States, contact the national toll-free Poison Help line at 1-800-222-1222, or call 911 if the individual is seizing, has collapsed, or is struggling to breathe. Immediate expert guidance is required to manage the rapidly developing symptoms of nicotine poisoning.
When speaking with the emergency operator or Poison Control, have the e-liquid container readily available. Medical professionals need the exact nicotine concentration, the approximate volume swallowed, and the age and weight of the person who ingested the liquid.
Do not attempt to induce vomiting unless a medical professional specifically instructs you to do so. While waiting for emergency services to arrive, monitor the person’s consciousness and breathing closely. Hospital treatment will focus on supportive care, which may include administering medications to manage seizures, regulating heart rate and blood pressure, and potentially using activated charcoal to limit nicotine absorption if the ingestion was very recent.