Nicotine poisoning of infant highlights 'E-cig' dangers, docs report

May 8, 2014 by E.j. Mundell, Healthday Reporter
Nicotine poisoning of infant highlights 'E-cig' dangers, docs report
10-month-old boy was sickened but survived toxic ingestion of liquid used for 'vaping'.

(HealthDay)—The story of a 10-month-old boy rushed to a hospital after ingesting the refill liquid used in e-cigarettes spotlights an emerging safety issue, the doctors who treated him say.

The child recovered. But the consequences of children accidently consuming the nicotine in these refill vials can easily become tragic, Dr. Robert Bassett, of Einstein Medical Center in Philadelphia, and two colleagues report in the May 7 issue of the New England Journal of Medicine.

Just "one teaspoon of a 1.8 percent nicotine solution could be lethal" to a 200-pound person, the doctors pointed out.

The recent rise in such poisonings among children, tied to the surging popularity of , highlights "the need to educate patients and parents about this danger and advocate for measures that will help prevent potentially fatal liquid nicotine poisoning of infants and young children," the physicians said.

The Philadelphia case report is hardly an isolated one, experts note. In April, the U.S. Centers for Disease Control and Prevention warned that the number of calls to poison control centers for nicotine poisoning from e-cigarettes has risen dramatically in recent years. Calls related to poisoning from the liquid nicotine used in e-cigarettes ran at a rate of roughly one a month in 2010, but jumped to 215 in February of this year alone.

Even more troubling, more than half (51 percent) of the poison calls involved children aged 5 and younger, while 42 percent involved people aged 20 and older, the CDC said.

"We have not had an unintentional poisoning death from e-cigarettes yet in the United States that we know of, but the potential is there given the amount of concentrated nicotine in these solutions—it would not take a lot for a child death to occur," Dr. Tim McAfee, director of the CDC's Office on Smoking and Health, said at the time.

In the Philadelphia case, Bassett and his colleagues said the boy was taken to the hospital after ingesting a "small" amount of e-liquid nicotine bought at a commercial vaping (or "vape") shop. The liquid contained 1.8 percent nicotine as well as "unknown concentrations" of other chemicals. After drinking the toxic liquid, the boy began vomiting, his heart rate sped up, and he exhibited loss of muscle control, the doctors reported.

The 10-month-old was lucky, however, because he never lost consciousness and his symptoms gradually subsided about six hours after first being admitted to the hospital.

But the physicians who treated him said the case raises troubling issues.

"The [U.S.] Food and Drug Administration does not currently regulate nontherapeutic nicotine; this raises concerns that in the ballooning unregulated liquid nicotine market there may be variability in nicotine dosing and introduction of unintended toxic ingredients," they wrote.

There's also a lack of consistent package labeling or child-protective packaging, the doctors noted. Many of the refill vials carry colorful labeling, "suggestions of edible ingredients ['lemonade']," and even "visually appealing cartoons" that might attract a child's curiosity, Bassett's team said.

Speaking at the time of the CDC's warning, experts agreed that the danger to children from e-cigarette refills is real.

Dr. Vincenzo Maniaci, an emergency medicine specialist at Miami Children's Hospital, said that "the concentration of nicotine in these solutions is significant and they need to be made childproof and regulated. Especially for kids under the age of 5, this amount of nicotine can be fatal."

The CDC's McAfee noted that the U.S. Food and Drug Administration is planning to propose regulations for e-cigarettes. He added that he hopes these regulations will include how the product is packaged, including childproof caps and warning labels.

"These things can be hardwired into these products, rather than being left to the whim of the manufacturer," he said.

Poisoning from the liquid nicotine in e-cigarettes can happen in one of three ways: by swallowing it; inhaling it, or absorbing it through the skin or membranes in the mouth and lips or eyes, McAfee said. Once it is in a person's system, nicotine can cause nausea, vomiting or seizures.

If those symptoms occur, the patient will typically be told to go straight to the emergency room, said Amy Hanoian-Fontana, from the Connecticut Poison Control Center.

If there are no symptoms, then the patient will be told to stay home and the center will call again in a few hours to see how the patient is doing. If liquid nicotine was spilled on the skin, the person should wash his or her skin in lukewarm water for about 20 minutes, Hanoian-Fontana added.

"We want to know what happened, when it happened and if the person is having any effects from the liquid nicotine," she explained. "Then we are going to make a determination whether this is something we can keep at home, or if they are having severe symptoms we may recommend that they go into the emergency department. It's very case-based, depending on the situation."

Explore further: Spike in US poison calls over e-cigarettes (Update)

More information: Visit the U.S. Food and Drug Administration for more on e-cigarettes.

Related Stories

Spike in US poison calls over e-cigarettes (Update)

April 3, 2014
The number of calls to US poison control centers about accidents with bottles of liquid nicotine for refilling e-cigarettes—many involving children—has spiked in recent years, health authorities said Thursday.

Nicotine 'e-liquids' pose serious health threat

March 25, 2014
(HealthDay)—A potent, liquid form of nicotine poses a serious and potentially deadly threat, but is sold legally in stores across the United States and online. The so-called "e-liquids"—the key ingredients in e-cigarettes—are ...

Young parents who use e-cigarettes believe devices are safer for those around them

May 4, 2014
Many young parents are using electronic cigarettes, and despite any evidence for safety, the vast majority of young adults who have used the devices believe they are less harmful than regular cigarettes, according to research ...

E-cigarette vapor contains potentially harmful particles, review says

May 7, 2014
(HealthDay)—E-cigarettes may not be as harmless as they initially seemed. New research suggests that e-cigarette vapor produces tiny particles that users suck deep into their lungs, potentially causing or worsening respiratory ...

Study documents secondhand exposure to vapors from electronic cigarettes

December 13, 2013
Electronic cigarettes, when used indoors, may involuntarily expose non-users to nicotine, according to a study led by Maciej Goniewicz, PhD, PharmD, of Roswell Park Cancer Institute (RPCI) and published by the journal Nicotine ...

E-cigarettes: Gateway to nicotine addiction for US teens, says study

March 6, 2014
E-cigarettes, promoted as a way to quit regular cigarettes, may actually be a new route to conventional smoking and nicotine addiction for teenagers, according to a new UC San Francisco study.

Recommended for you

Marijuana use does not lower chances of getting pregnant

January 22, 2018
Marijuana use—by either men or women—does not appear to lower a couple's chances of getting pregnant, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.

Sleep better, lose weight?

January 17, 2018
(HealthDay)—Sleeplessness could cost you when it's time to stand on your bathroom scale, a new British study suggests.

Who uses phone apps to track sleep habits? Mostly the healthy and wealthy in US

January 16, 2018
The profile of most Americans who use popular mobile phone apps that track sleep habits is that they are relatively affluent, claim to eat well, and say they are in good health, even if some of them tend to smoke.

Improvements in mortality rates are slowed by rise in obesity in the United States

January 15, 2018
With countless medical advances and efforts to curb smoking, one might expect that life expectancy in the United States would improve. Yet according to recent studies, there's been a reduction in the rate of improvement in ...


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.