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27,28 Genetic polymorphisms in the genes responsible for ion channels, neurotransmitter receptors, and metabolic enzymes that are involved in the metabolism of nicotine and e-liquid may also affect the likelihood of developing seizures after using e-cigarettes

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However, in people taking multiple serotonergic medications, alcohol may contribute to a higher total serotonin burden, and any symptom cluster involving agitation, muscle twitching, rapid heart rate, fever, and confusion warrants emergency evaluation regardless of the final diagnosis