Acute Psychosis in Withdrawal from Nicotine Vaping in a YoungMan with Comorbid Diabetic Ketoacidosis and Cannabis Use

Electronic delivery of nicotine, also termed“vaping,”has a growing evidence base suggesting potential harm through both exposureand withdrawal effects. The current report presents the case of a young man with multiple medical comorbidities, including insulin-dependent diabetes mellitus on an insulin pump and presumed Gilbert’s disease, and chronic cannabis use who experienced acuteagitation with hallucinations in the context of quitting his vape pen“cold turkey”or abruptly discontinuing use without a nicotinereplacement. While undergoing hospitalization for his complaint of nausea and vomiting in the context of euglycemic diabeticketoacidosis and cannabis use, his psychotic symptoms became evident and continued until beginning a nicotine replacementpatch. A few months later, the patient returned to the hospital again for nausea and vomiting in the context of euglycemic diabeticketoacidosis and reported cannabis use, however this time without psychosis, and notably after resuming and continuing use ofe-cigarette with nicotine replacement delivered on admission. This is thefirst reported case of acute psychosis related to abruptvaping withdrawal and adds to the plethora of information regarding potential risks associated with electronic cigarette use.