Saturday, March 28, 2015

E-cigarette Q&A: Keeping kids safe from liquid nicotine

Jeanette Trella, PharmD, managing director of The Poison Control Center (PCC) at The Children's Hospital of Philadelphia, answers questions about the recent increase of e-cigarette related calls to poison centers and how to properly store liquid nicotine.

E-cigarette Q&A: Keeping kids safe from liquid nicotine

With e-cigarettes becoming more popular, the number of calls of exposure to e-cigarette liquids containing nicotine to poison control centers have significantly grown, according to a CDC study published in Morbidity and Mortality Weekly Report earlier this month.

The number of calls rose from one per month in September 2010 to 215 per month in February 2014. More than half (51.1 percent) of the calls to poison centers due to e-cigarettes involved young children under age 5, and about 42 percent of the poison calls involved people age 20 and older.

Data for this study came from the poison centers that serve the 50 states, the District of Columbia, and U.S. Territories. The study examined all calls reporting exposure to regular cigarettes, e-cigarettes, or nicotine liquid used in e-cigarettes. 

Poisoning related to e-cigarettes involves the liquid containing nicotine used in the devices and can occur in three ways: by ingestion, inhalation or absorption through the skin or eyes.

“This report raises another red flag about e-cigarettes – the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, M.D., M.P.H in a written statement. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”

We asked Jeanette Trella, PharmD, managing director of the Poison Control Center at The Children’s Hospital of Philadelphia, about the rise in cases related to e-cigarette liquids that the Center has received and tips for properly storing the liquid nicotine.

What increase in e-cigarette-related calls has The PCC at The Children's Hospital of Philadelphia seen? Can you talk generally about some of the cases that PCC has handled? 

The PCC has handled 45 calls related to e-cigarettes and their refillable liquid, 26 of which were from 2013 to present. Of the exposures to the liquid refill product, 68 percent of all cases involved children less than 6 years of age. In addition to children ingesting the liquid, we also had cases in which the refillable liquid bottles were mistaken for eye drops, which ultimately led to burns of the eye.  

What are potential symptoms if this liquid is swallowed, depending on the amount?

Electronic cigarette liquid refills typically contain nicotine as a primary active ingredient. Nicotine may cause nausea, vomiting, dizziness, salivation and tearing, diarrhea and muscle weakness. Confusion, coma, seizures and death may occur with high doses.

The most common symptoms reported to the PCC were nausea and vomiting, however, there was a case of severe toxicity which manifested as nausea, vomiting, diminished responsiveness and ataxia (balance difficulties).

How should e-cigarette liquids be stored properly? Would you advise that parents/caregivers specifically tell a child not to ingest the liquid before storing in properly?

E-cigarette liquid refills are poorly regulated and may be distributed without child-protective packaging, with inadequate labeling, and with questionable quality control of ingredients. They can contain high amounts of nicotine and are typically flavored and in colorful containers, which can be enticing to young children. The increasing commercial sales of e-cigarettes and liquid refills may increase the risk of toxic exposures to these products.

With regard to poison related calls involving children, inclusive of e-cigarette cases, the majority are in children less than three years of age.  Rather than showing a toddler the bottle and suggesting not to drink it, we recommend restricting visibility and access to such products in the home. As with all household poisons, store e-cigarette devices and their liquid refills out of reach and out of sight of children.

What should you do if you suspect that your child has ingested e-cigarette liquid?

If you suspect your child has been exposed to e-cigarette liquid, then please call the Poison Control Center at 1-800-222-1222. We have specially trained nurses and pharmacists available to answer your questions 24/7 at no charge.


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Anna Nguyen Healthy Kids blog Editor
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The Healthy Kids blog is your window into the latest news, research and advice around children's health. Learn more about our growing list of contributors here.

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Anna Nguyen Healthy Kids blog Editor
Sarah Levin Allen, Ph.D., CBIS Assistant Professor of Psychology at Philadelphia College of Osteopathic Medicine
Stephen Aronoff, M.D., M.B.A. Chair of the Department of Pediatrics at Temple University Hospital
Peter Bidey, D.O. Medical Director of Family Medicine at Philadelphia College of Osteopathic Medicine
Christopher C. Chang, MD, PhD, MBA, FAAAAI, FACAAI Associate Professor of Medicine in division of Rheumatology, Allergy and Clinical Immunology at UC Davis
Katherine K. Dahlsgaard, Ph.D. Lead Psychologist of The Anxiety Behaviors Clinic at Children's Hospital of Philadelphia
Gary A. Emmett, M.D., F.A.A.P Director of Hospital Pediatrics at TJU Hospital & Pediatrics Professor at Thomas Jefferson Univ.
Magee DeFelice, M.D. Division Chief of Allergy and Immunology at Nemours/Alfred I. duPont Hospital for Children
Hazel Guinto-Ocampo, M.D. Chief of Pediatric Emergency Services at Nemours duPont Pediatrics/Bryn Mawr Hospital
Rima Himelstein, M.D. Adolescent Medicine Specialist at Crozer-Keystone Health System
Jessica Kendorski, PhD, NCSP, BCBA-D Associate Professor in School Psychology/Applied Behavior Analysis at Philadelphia College of Osteopathic Medicine
Anita Kulick President & CEO, Educating Communities for Parenting
Janet Rosenzweig, MS, PhD, MPA VP for Programs & Research for Prevent Child Abuse America
Beth Wallace Smith, R.D. Registered Dietitian at Children's Hospital of Philadelphia
Emiliano Tatar, M.D. Pediatrician at Einstein Healthcare Network Roxborough Plaza
Jeanette Trella, Pharm.D Managing Director at The Poison Control Center at CHOP
W. Douglas Tynan, Ph.D., ABPP Director of Integrated Health Care for American Psychological Association
Flaura Koplin Winston, M.D., Ph.D. Scientific Director of the Children’s Hospital of Philadelphia’s Center for Injury Research and Prevention
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