Electronic cigarettes (e-cigarettes) are becoming a popular replacement for traditional tobacco products. But with the increase in use, there has been an increase in poisonings. According to the CDC, calls to poison centers involving children and adults increased from 1 per month in September 2010 to 215 per month in February 2014.

E-cigarettes contain concentrated nicotine in a cartridge that is vaporized by a heating coil. Poisonings can involve the cartridge itself or the e-liquid from refill bottles. Many of the e-liquid nicotine products are flavored (fruit, bubble gum, chocolate) making them attractive to toddlers and teens, and they are often sold in containers without child-resistant caps. Because e-liquid nicotine is highly concentrated, severe toxicity and death is possible with very small volumes, as little as a fraction of a milliliter or a few drops.

Nicotine stimulates the nervous system and in toxic doses can cause nausea, vomiting, diarrhea, salivation, sweating, weakness, high blood pressure, fast heartbeat, then deteriorates to low blood pressure, slow heartbeat, irregular heartbeats including cardiac arrest, lethargy, confusion, tremors, seizures, coma, and respiratory muscle paralysis leading to death.

A child who ingests any amount of e-liquid nicotine should be immediately evaluated by a physician.

On April 24, 2014, the FDA proposed a rule that would give the agency the authority to regulate e-cigarettes. This would require manufacturers to report ingredients, conform to strict standards, limit sales to those who are of legal age, and mandate the posting of health warnings. To view the proposed rule or to comment, go to www.fda.gov/TobaccoProducts/Labeling/ucm388395.htm .

Summarized from the Maryland Poison Center April/May 2014 ToxTidbits.