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Vaginal button battery insertion in an adult patient

arette cartridge just prior to symptom onset. The patient denied any other ingestions or exposures. Product information was unknown, including whether the product was modified in any way. The patient’s initial symptomatology was thought to be consistent with nicotine toxicity, however, sympathomimetic and antimuscarinic toxicity were also considered. Comprehensive urine gas chromatography/mass spectrophotometry (GC/MS) to exclude other potential causes revealed three compounds of toxicological significance: Lorazepam (>500 ng/mL), Delta-9 Carboxy THC (31 ng/mL), and Diphenhydramine (1100 ng/mL). Nicotine and its metabolite, cotinine, were not detected in the sample. The diphenhydramine serum concentration is consistent with those reported with severe diphenhydramine overdose (500–8900 ng/mL) [3]. The rise in e-cigarette exposures and poisonings, especially amongst adolescents, raises several public health concerns, including the potential connection between ecigarettes use and a risk of seizures. Although nicotine toxicity can cause seizures, most reports in the literature have occurred in the setting of e-liquid ingestions. It is currently unclear if vaping e-cigarettes can produce high enough nicotine concentrations to cause seizures. This case demonstrates how an accurate history of exposure is often not possible or unreliable. Without confirmatory drug testing, a presumptive clinical effect can easily be misinterpreted, as in the above case. Despite clear histories of exposure and symptomatology consistent with a particular exposure, without confirmatory drug concentrations, it is possible that an adverse effect is attributed to the incorrect substance. We believe that in addition to obtaining more detailed clinical information about these events, comprehensive drug testing is vital in providing objective evidence of adverse clinical observations and determining a direct relationship between use of e-cigarettes and risk of seizures.