E-cigarettes, despite the fact that they are designed to be a healthier alternative to smoking, have been producing an unfortunate and tragic consequence that have left many people questioning their true safety. E-liquid poisoning, especially among children, has been a topic of concern and has become a headline appearing in newspapers and on newsfeeds all over the country.
Good thing too. Since the news of e-cigarette poisoning became more widespread we have seen a sharp decline in calls to poison control centers, attributed to education and the responsibility of electronic cigarette users. However, there are still a lot of unanswered questioned about e-liquids, and their poison potential, that are worthy of further examination.
E-liquid is the primary component in e-cigarettes. It is a liquid that contains only a few ingredients that include, most notably, nicotine. While the e-liquid is not considered a generally dangerous substance when vaporized, the high concentration of nicotine that can be consumed all at once if orally ingested makes them a potentially hazardous material.
The real danger was magnified in December 2014 when a toddler lost their life as a result of the accidental consumption of a bottle of e-liquid. It’s not hard to imagine that little ones could mistake e-liquids for a tasty treat; e-liquids are small and come in appetizing looking flavors and packages that can look like candy to a young eye. This is why it is more important now than ever to understand what the real story is behind e-liquid poisonings.
Nicotine Poisoning can affect someone in three ways, by swallowing, by inhaling or by absorbing it through the skin. E-liquid is not the only substance that can produce nicotine poisoning, other tobacco products carry this danger too. However, beginning back in late 2010 e-cigarettes, and more specifically their e-liquid, began resulting in calls to poison control centers too. While there is a certain danger in young children absorbing nicotine through topical contact on the skin, the primary concern is in the danger of young ones swallowing e-liquid.
They may look appetizing at first, but it does not take much before a child generally realizes there isn’t a need for consumption. Nicotine overdoses are rare for a lot of reasons, but the side effects are one of the major indicators to shut off the nicotine intake. In fact, Public Health England who has done extensive work on e-cigarettes and their safety, believes nicotine poisoning is truly of low risk, stating: “Serious nicotine poisoning seems normally prevented by the fact that relatively low doses of nicotine cause nausea and vomiting, which stops users from further intake.”
That being said, the amount of nicotine that can trigger a response, especially in a young child, is far smaller than what could affect a grown adult. And it does not take much nicotine to even enter the lethal dose area of concern.
How Much Nicotine is Dangerous or Fatal?
The truth about the amount of nicotine that is fatal is a large grey area. Since we have seen that the amount of nicotine available to a child in just one e-liquid bottle can result in death, it is always better to err on the side of caution when estimating the amount that constitutes a fatality risk. Especially when considering younger children, with lower weights, who do not have enough body mass in their system to fight off a nicotine over dose.
A lethal dose of nicotine has been estimated to begin at about 40 mg for an adult. More specifically, a lethal dose is estimated at anywhere from 1 to 2 mg per pound in an adult, but it is actually far less in children. A lethal dose in children is estimated at closer to .25 mg per every pound, meaning a child who weighs 20 pounds could be exposed to a lethal dose at as little as 5 mg. It’s important to remember while this is considered a lethal dose, it is different for everyone, and a child could easily ingest more and survive with only minor symptoms. When making estimations with someone’s life you can never be too cautious, so lethal dose estimations will always be on the lowest side.
Public Health England also note that this lethal dose estimation may be considerably low stating: “If the 10ml bottle of e-liquid was drunk, it would cause nausea and vomiting but would be unlikely to inflict serious harm. “
While some e-liquid contains no nicotine at all, those that do clearly display their nicotine strength and content right on their packaging. E-liquids generally range from 0 nicotine content to 36 mg/ml concentration. What that means is that a 10 ml bottle of e-liquid at the highest strength would contain 360 mg of solution (36 mg x 10 ml). This is some of the highest strength e-liquid, but still even a lower dose nicotine strength bottle of 12 mg/ml, would still contain more than 20 times what would be needed to be considered a lethal dose in children, if they consumed the whole bottle.
Luckily, most children are not too keen on the taste, and do not consume large enough amounts to be considered close to lethal. Even though the amount needed to be considered lethal is so small, most would not consume enough to constitute any more than some vomiting, and perhaps dizziness, which are among the most common symptoms of nicotine poisoning.
Reported Cases of Nicotine Poison
As would be imagined with the rise in the popularity of e-cigarettes, so has risen the occurrence of e-liquid poisoning cases, this is natural. Still the side effects, while unpleasant, are not often so tragic, such as the case with the child in New York. Most cases, if anything, will result with a call to a poison control center or a physician. That being said, there is still plenty of evidence that nicotine poisoning cases have increased significantly since the rise in the popularity of e-cigarettes.
The first exposure call related to an e-cigarette product came into a poison control center in September 2010; the first child exposure followed in November 2010. A gradual increase in exposure cases occurred until early 2013 when a dramatic increase in cases caused much concern among the health care and e-cigarette communities. E-cigarette poisoning related calls hit their peak in April 2014 and at that point e-liquid cases comprised 35% of all nicotine-related exposure calls. In the 2013 Annual Report of the American Association of Poison Control Centers’ National Poison Data System the explain the amount of cases related to e-cigarettes: “In children, e-cigarettes now account for roughly 25% of exposures, while in other age groups, e-cigarettes exposures have surpassed other tobacco products and account for as many as 65% of exposures.” In addition, serious cases involving children also seem less prevalent, the report continues, “E-cigarette exposures in children under age 5 have serious outcomes in only 1.9% of cases compared with 5.3% in other ages.” The report continues to account a decline in exposures since April 2014, which they believe is related to the “increased scrutiny on e-cigarettes and increased state and local regulation.”
How Does Nicotine Poisoning Stack up against Other Poison Calls
Since e-cigarettes have become more popular, the concern for e-liquid poisoning is very real. All responsible vapers know that e-liquids can pose a certain risk to little ones, and as a result keep them put away safely and securely. Even responsible electronic cigarette users can make mistakes, and when these things happen, the results can be devastating. Still, the reality of the situation is there are less nicotine poison calls as a result of e-liquid than people general realize, a mistake easy to make when every case is ripe for the headline news. The truth is the amount of poisoning cases is way lower than most other poison calls.
Back in 2013, there were 1,543 exposures to nicotine reported to poison control centers; this includes all nicotine calls from exposure to chewing tobacco, regular cigarettes as well as e-liquids. In comparison, analgesics, basic over the counter pain medication, was responsible for just under 300,000 reported calls to the center. Alcohol was reported to be the cause of just over 70,000 calls; even common house or garden plants were responsible approximately 46,000 cases. Even when the rise in reported e-liquid cases rose to 3,783 in 2014, the number still pales in comparison to other more common household items. In addition, with youth under 5, the most prominent age group in e-cigarette liquid poisoning cases, the most common ingested items are cosmetic products or cleaning products. Both of these, depending upon the ingredients, can have disastrous consequences, just as dire as those you hear of in e-cigarette cases too.
How do We Solve the Problem?
Responsibility on behalf of the e-cigarette community has already put a major dent in this problem. Once news spread of the potential dangers of e-liquid poisoning surfaces, responsible vapers took the necessary steps to keep the potentially dangerous liquid away from little hands, and as a result we saw a drop in calls to position control centers across America. The calls have remained at a steady rate throughout 2015, however, as vaping continues to grow in popularity, but the cases of poisoning do not rise, you can assume there is a stronger presence on responsibility and education in the vaping community.
Some suggest that regulations will not only help keep vaping away from teens and adolescents, but that it will create restrictions, such as child-proof packaging, that could help curb the poisoning cases to a mere minimum. Several e-liquid manufacturers are already beginning to offer child-proof packaging to help keep nicotine poisoning cases more and more rare. With the popularity of electronic cigarettes only rising continuing education and responsibility will continue to be the best way to keep poisoning cases at bay.