Unintentional Pediatric Ingestion of Electronic Cigarette Nicotine Refill Liquid Necessitating Intubation

Noble, Matthew J.; Longstreet, Beck; Hendrickson, Robert G.; Gerona, Roy

doi:10.1016/j.annemergmed.2016.08.448

Cited by 33 publications

(20 citation statements)

References 5 publications

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“…However, despite widespread availability, these e-liquids have had minimal federal and state regulation. Reports suggest that products may be unreliably labeled and demonstrate inconsistent estimates of actual nicotine concentration [1]. E-cigarette exposures and poisonings, especially in young children, have increased significantly in recent years [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

An epidemiologic and clinical description of e-cigarette toxicity

Hughes

Hendrickson

2018

Clinical Toxicology

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Introduction: E-cigarettes are battery-powered electronic nicotine delivery systems that simulate smoking by vaporizing nicotine-containing solutions. Systematic published data on e-liquid toxicity and exposures are limited to case reports and retrospective studies. Prospectively-collected data on the type of exposure, symptomatology, duration of symptoms, and concentration/flavor of e-fluids has not been published. Methods: This was a prospective observational study over a 42-month period (07/01/2014-12/31/ 2017). For all calls to a single poison center that involved e-cigarette devices or refill fluid, a data collection instrument was filled out by the specialist in poison information (SPI). Results: Two hundred sixty-five total cases were identified, including 193 children and 72 adults. The majority of both pediatric (72%; 139/193) and adult (61%; n ¼ 44/72) exposures involved e-liquid refill containers or fluid. Fifty-six percent (n ¼ 108/193) of pediatric exposures involved ingestion of refill liquid. Though children who ingested e-liquid received only a small amount, initial symptoms were evident in 32% (n ¼ 35/108) of cases. Children who did not ingest or inhale the products were less likely to develop toxicity. Only 2 children who were asymptomatic on initial call became symptomatic on follow-up. Most patients symptoms resolved within 4 hours. Seventy-one specific products/brands were identified with nicotine concentrations ranging from 0 mg/mL to 60 mg/mL with one product containing 3000 mg in a single bottle. A variety of flavors were identified, including several with names that may be attractive to toddlers or adolescents. Discussion: E-cig exposures tend to produce irritant effects from topical exposures and nicotine toxicity from ingestions, as well as some dermal and "sucking" toddler exposures. Conclusion: Exposure to e-cig fluid or device frequently causes mild symptoms and rarely may produce systemic nicotine toxicity.

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Section: Introductionmentioning

confidence: 99%

An epidemiologic and clinical description of e-cigarette toxicity

Hughes

Hendrickson

2018

Clinical Toxicology

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“…34 Concentrated nicotine solutions, such as 60 mg/mL, are also available to consumers, who can then dilute and mix their own e-cigarette liquids. 16,34 A young child can easily ingest a lethal dose in 1 swallow. 6 In 1 case report, a 15 month-old child died after ingesting a dose of 4.1 mg/kg of liquid nicotine.…”

Section: Figurementioning

confidence: 99%

E-Cigarette and Liquid Nicotine Exposures Among Young Children

et al. 2018

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RESULTS:There were 8269 liquid nicotine exposures among children <6 years old reported to US poison control centers during the study period. Most (92.5%) children were exposed through ingestion and 83.9% were children <3 years old. Among children exposed to liquid nicotine, 35.1% were treated and released from a health care facility, and 1.4% were admitted. The annual exposure rate per 100 000 children increased by 1398.2% from 0.7 in 2012 to 10.4 in 2015, and subsequently decreased by 19.8% from 2015 to 8.3 in 2016. Among states without a preexisting law requiring child-resistant packaging for liquid nicotine containers, there was a significant decrease in the mean number of exposures during the 9 months before compared with the 9 months after the federal child-resistant packaging law went into effect, averaging 4.4 (95% confidence interval: −7.1 to −1.7) fewer exposures per state after implementation of the law.CONCLUSIONS: Pediatric exposures to liquid nicotine have decreased since January 2015, which may, in part, be attributable to legislation requiring child-resistant packaging and greater public awareness of risks associated with electronic cigarette products. Liquid nicotine continues to pose a serious risk for young children. Additional regulation of these products is warranted.abstract

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“…Similar findings of rapid increase in exposure calls associated with e-cigarettes have been reported by others. 7,8 Additionally, serious health effects associated with e-cigarettes involving children have also been reported, 9,10 including death, burn, respiratory issues, and severe liver toxicity.…”

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confidence: 99%

Tobacco-related Poison Events Involving Young Children in the US, 2001-2016

Wang¹,

Rostron²

2017

tobacco reg sci

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Objective: In this paper, we describe trends in tobacco-related poison exposure calls (calls) involving young children in the US. Methods: Data were from the National Poison Data System between January 1, 2001 and October 31, 2016. We analyzed data on calls involving children younger than 5 years old. We describe trends in calls over time and call frequency by age, tobacco product type, level of care, and other characteristics of calls. Results: During 2001–2016, there were 123,876 calls involving young children. During the study period, calls increased for most product types; e-cigarette-related calls increased from 7 in 2010 to 2558 in 2015. In calls with information on level of care (92.2%), 278 children were admitted to an intensive care unit, 497 were admitted to a hospital noncritical care unit, and 19,834 were treated and released. Conclusions: Tobacco-related poison events commonly occur in the US and can have serious health consequences. More than 123,000 events among young children were reported during 2001–2016, but this likely represents a small portion of actual tobacco-related poison events due to underreporting. It is critical to continue to monitor tobacco-related poison events and develop strategies to prevent tobacco-related harm.

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Unintentional Pediatric Ingestion of Electronic Cigarette Nicotine Refill Liquid Necessitating Intubation

Cited by 33 publications

References 5 publications

An epidemiologic and clinical description of e-cigarette toxicity

An epidemiologic and clinical description of e-cigarette toxicity

E-Cigarette and Liquid Nicotine Exposures Among Young Children

Tobacco-related Poison Events Involving Young Children in the US, 2001-2016

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