Acute exposures to e‐cigarettes and heat‐not‐burn products reported to the Czech Toxicological Information Centre over a 7‐year period (2012‐2018)

Abstract

E‐cigarettes and heat‐not‐burn cigarettes (HNBC) present new health risks due to their rising popularity, high content of nicotine and serious adverse effects. The objective of the study was to analyse the cases of acute exposure to e‐cigarettes, e‐liquids and HNBC products containing nicotine that led to toxicological consultations at our poisons control centre during a 7‐year period (2012‐2018) and identify the categories of special concern that require further investigation and intervention. The demographic, toxicological and clinical data were analysed by descriptive statistics. Poisoning severity score (PSS) was estimated. From 119 229 consultations, 148 cases concerned acute exposure to e‐cigarettes. Children and adolescents were exposed in 91 (61%) cases, including exposure of neonates and infants in 54 (36%) cases. The main route of exposure was ingestion in 129 (87%), inhalation in nine (6%), ocular in six (4%) and intravenous administration in three (2%) cases. The source of exposure was the cartridge with e‐liquid (107; 72%), refillable tank in 29 (20%) and HNBC refill in nine (6%) cases. The reason for exposure was accidental in 110 (74%), incorrect application of the device in 10 (7%), abuse in six (4%), suicide attempt in six (4%) and other/unknown in 16 (11%) cases. The dose estimation was severe/lethal in 6 (4%), toxic in 53 (36%), low‐to‐moderate in 35 (24%) and unknown in 54 (36%) cases. Vomiting was observed in 38 (26%) patients; 72% of patients were hospitalised. In symptomatic cases, 41 patient had PSS 1, 12 patients had PSS 2, and one patient had PSS 3. Activated charcoal was applied in 57 (39%) patients, and symptomatic treatment was recommended in 75 (51%) patients. Cases of unintentional exposure of children demonstrate the need for preventive risk reduction measures.

Association of heated tobacco product use and secondhand smoke exposure with suicidal ideation, suicide plans and suicide attempts among Korean adolescents: A 2019 national survey

“…There is limited research on the association between HTP use, exposure to toxic constituents, and suicidality. A recent study found that HTPs might be used as a tool for suicide attempts 26 .…”

Potentially fatal ingestion of heat‐not‐burn cigarettes successfully treated by gastric lavage

“…4 Surprisingly, acute intoxication attributed to nicotine overdose related to these products has been reported. 5 Generally, highly concentrated liquid nicotine or "e-liquid" that e-cigarettes aerosolize is much more hazardous because of its quick absorption. 1 However, ingestion of large amounts of HNB cigarettes can also be life-threatening because they contain as much nicotine as regular tobacco.…”

“…Traditionally, intake of 40 to 60 mg of oral nicotine or 5 cigarettes has been shown to be lethal; however, the actual lethal dose is implied to be much greater based on previous reports showing that the majority of patients who were potentially harmed were asymptomatic or presented with only mild symptoms. 5 Possible explanations include decrease of actual intake as a result of vomiting, difference in absorption rates between cigarette sticks and nicotine liquid, and the rapid metabolism of nicotine in the liver. 1,9 Nevertheless, the present case could have been fatal given a previously reported case of lethal acute nicotine intoxication attributed to the intentional ingestion of 9 regular cigarettes.…”

“…However, there is insufficient evidence to demonstrate that these cigarettes are less harmful than conventional cigarettes 4 . Surprisingly, acute intoxication attributed to nicotine overdose related to these products has been reported 5 . Generally, highly concentrated liquid nicotine or “e‐liquid” that e‐cigarettes aerosolize is much more hazardous because of its quick absorption 1 .…”

Tobacco Smoking From the View of Different Professions, Treatment, Smoking Cessation, Harm Reduction

“…Obecně samozřejmě nelze žádný nikotinový výrobek doporučovat nekuřákům včetně dětí. Zejména u nich může dojít k intoxikaci nikotinem při vypití tekutiny EC, u nás se jedná ročně řádově o desítky telefonátů (dotazů) na Toxikologické informační středisko (11).…”