A Review of Electronic Cigarettes and Liquid Nicotine Poisoning Exposure Cases in the United States

Abstract

Purpose: In 2007, electronic cigarettes (e-cigarette) were introduced as a smoking cessation device. Since then, its sale and marketing has been expanded annually. Concomitantly, there is an increase in the electronic cigarette (e-cigarette) and liquid nicotine exposure cases reported to the United States (US) poison control centers. The purpose of this review is to assess the exposure cases reported to US poison control centers to characterize the adverse health effects of e-cigarette and liquid nicotine use. Methods: The PubMed database was searched for e-cigarette and e-liquid exposure reports since 2010. The qualitative analysis was conducted to depict the characteristics related to the incident cases and health outcomes of e-cigarette and e-liquid exposure to support public awareness. Results: Since 2010, there was an increase in e-cigarette exposure incidents with ingestion, inhalation, ocular and dermal identified as the commonly reported routes of exposure in both children and adults. The clinical symptoms were well characterized based upon the specific route of exposure. The exposure incidents were categorized into age, sex, type of exposure, symptoms, management site and medical outcome. The children less than 5 years of age were unintentionally exposed followed by both unintentional and intentional exposure in adults. The reported medical outcomes have a range from minor effects exhibiting symptoms that were not bothersome to major effects with life-threatening symptoms, and death. The short-term or acute exposure was mostly associated with mishandling or misuse of the e-cigarette device or e-liquid. The case reports of young adult males who are linked to intensive use of e-cigarettes show lung injury. Conclusion: E-liquid and e-cigarette use continue to pose a serious health risk for both adults and children. There is accumulating data of incidents associated with short-term e-cigarette use or intensive use of e-cigarettes. However, monitoring of the long-term health effect of e-cigarettes is needed in order to raise public awareness among young adults.

Carcinogenic and non-carcinogenic health risk assessment of organic compounds and heavy metals in electronic cigarettes

“…The purpose of an exposure assessment is to estimate the extent of public exposure to the emitted substance. In a study by Ayesha 23 , it was shown that accidental ingestion of e-liquids is also toxic to humans. Unintentional exposure in children and adults accounted for 87%, with intentional exposure 5% and unknown exposure < 1%.…”

“…E-cigarette liquids are packaged in quantities ranging from 10 to 50 ml, and in a study by Ayesha 23 , 64.8–92.5% of people were intoxicated by ingesting whole or partially leaked e-liquids. Due to the lack of patient data on acute exposure, we assumed an acute exposure of 10 ml of e-liquid for oral and dermal exposure to calculate the acute exposure to the hazardous substance.…”

“…E-cigarette liquids contain glycerin and harsh-smelling additives that make it easy for the user to detect and deal with leaks if they occur, meaning that no large amounts of liquid will come into unknown contact with the skin and mouth in the event of a leak. Most users for various reasons for a small amount of leakage does not affect the use of only simple treatment, such as wiping the liquid and reassemble the device and continue to use, however, after wiping there will still be a certain amount of liquid remains on the surface of the device, and thus come into contact with the skin and the oral cavity, so we consider the exposure through leakage as unknown exposure, in the study of Ayesha 23 the percentage of unknown exposure is less than 1%; we therefore used the assumption that 1% (0.05 ml) of the 5 ml of liquid used per day (within the range of use described above) comes into contact with the skin and oral cavity through leakage or other ways.…”

“…Accidental ingestion of e-liquid may cause acute symptoms of poisoning, and studies have shown that there is an increasing trend of acute cases due to e-liquid exposure each year 23 . An increasing number of teenagers smoke e-cigarettes, and this is considered a trend.…”

Health Risk Assessment of Organic Compounds and Heavy Metals in Electronic Cigarettes

“…E-cigarette liquids are packaged in quantities ranging from 10-50 ml, and in a study by Ayesha [23], 64.8-92.5% of people were intoxicated by ingesting whole or partially leaked e-liquids. Due to the lack of patient data on acute exposure, we assumed an acute exposure of 10 ml of e-liquid for oral and dermal exposure to calculate the acute exposure to the hazardous substance.…”