E-cigarettes cause alarming increase in calls to poison control center

Kentucky Regional Poison Control Center sees 333-percent increase

LOUISVILLE, Ky. — As the debate about electronic cigarette regulation continues with the U.S. Food and Drug Administration (FDA) and device manufacturers, data from one state poses concerns that should be part of the conversation.

E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
The Kentucky Regional Poison Control Center of Kosair Children’s Hospital has received 39 calls about e-cigarettes so far this year, a 333-percent increase from nine calls received in 2012. Nationally, poison control centers have seen a 161 percent increase in calls from people with concerns about these devices. With sales of e-cigarettes doubling to $1.5 billion in the past year, the calls are likely to increase.
E-cigarettes consist of a rechargeable lithium battery, a liquid cartridge and an LED light at one end that simulates the burning effect of a regular cigarette. When the user inhales, or “vapes,” a heating element converts the liquid in the cartridge into a vapor. Cartridges typically contain nicotine, propylene glycol or glycerol, flavoring and other additives.
“More than half of the calls we have received were concerning children,” said Ashley Webb, Pharm.D., board-certified toxicologist and director of the Kentucky Regional Poison Control Center of Kosair Children’s Hospital.
“Kids are picking up the liquid cartridge when cartridges are left accessible or when an adult is changing the cartridge,” she said. “They’re also getting a hold of the e-cigarette and taking it apart to expose the liquid. They then either ingest the liquid or get it onto their skin. Even on the skin, the nicotine is absorbed and can create adverse side effects.”
These exposures raise a concern because of the concentrated nature of the cartridge fluid.
“The amount of nicotine in the cartridges is not regulated, but many contain more than 14 milligrams of nicotine,” said Dr. George Rodgers, associate medical director, Kentucky Regional Poison Control Center and professor and division chief of pediatric pharmacology and toxicology at the University of Louisville School of Medicine. “Severe cases of toxicity requiring hospitalization have been reported with children consuming 1.4 milligrams per kilogram of weight — equivalent to an average 2-year-old consuming the amount found in a cartridge,” he said. “And since children are not used to consuming nicotine, their symptoms may be more severe at lower levels.”
“Accidental exposure by children to e-cigarettes is a public health concern that we need to take seriously,” said Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health and Wellness in Louisville, Ky. “Parents need to be aware of the potential dangers to their children.”
Symptoms of severe nicotine exposure include a pale appearance, flushing, sweating, headache, dizziness, hyperactivity or restlessness, vomiting, diarrhea, rapid heart rate, increased blood pressure, salivation and teary eyes. In very severe cases, the heart rate and blood pressure begin to drop to dangerously low levels and the patient can lapse into a coma, followed by difficulty breathing and even death.
When on the skin, nicotine in liquid form is easily absorbed. Even small amounts can cause irritation and a burning sensation.
“Only a few of the calls we have received have been from children inhaling nicotine from the e-cigarette,” Webb said. “And so far only two of the calls involved symptoms severe enough to require emergency care. But it’s only a matter of time before a child experiences a severe reaction.”
“Parents need to consider these devices as a potential harm to children and, like other poisons, keep them out of reach,” said Dr. Stephen P. Wright, pediatrician and medical director of Kosair Children’s Hospital. “Since e-cigarettes are also unregulated, we don’t know what other toxins may be in them.”
An analysis done by the FDA in 2009 showed that e-cigarettes contain carcinogens and other hazardous chemicals, including diethylene glycol, an ingredient used in antifreeze. Researchers from the University of Athens in Greece found that e-cigarettes, thought by some to be a safer alternative to tobacco smoking, do have a harmful effect on the lungs, as reported in Medical News Today.
“Since the industry is still so new, we don’t yet know all of the long-term health effects of e-cigarettes to the user, in addition to any effects of secondhand vapor,” said Wright, who is also a professor of pediatrics at the University of Louisville School of Medicine. “While they are touted as a healthier alternative to cigarettes, the jury is still out. We do know that not smoking anything — especially around children — is always the best bet.”
About the Kentucky Regional Poison Control Center of Kosair Children’s Hospital
The primary mission of the Kentucky Regional Poison Control Center is to reduce illness and death from poisoning in Kentucky. The center provides 24/7 free and confidential access to specially trained nurses, physicians and pharmacists who are certified in toxicology. They are specialists in communicating advice to health care professionals, first responders, patients, parents, family members, the general public and the media. Some of the more common calls received involve medications, household cleaning products, plants and personal care items.
Calls also are answered about work-related exposures in farming and industry, food poisoning, insect and snakebites and a variety of other potential hazards. On average, the poison control center’s hotline at (800) 222-1222 receives a call every 7 minutes, 24 hours a day, 365 days a year — more than 72,000 calls annually — from all of Kentucky’s 120 counties. Three of every four patients from those calls are successfully managed safely and inexpensively at home, reducing unnecessary emergency room visits and/or shortening hospital stays. For additional information, visit KosairChildrensHospital.com/PoisonControl.
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