Since their release in 2007, consumers have increasingly looked to e-cigarettes as a way to get their nicotine without smoking. While reducing their risk to toxins from smoking, though, vapers are increasingly becoming victims of nicotine poisoning at the hands of their vaporizers and vape fluids.
Calls about exposures to e-cigarette now account for 41.7 percent of combined monthly e-cigarette and cigarette exposure calls to Poison Control Centers. An “exposure” means contact with the substance (e.g. ingestion, inhalation, absorption via skin or eyes, etc.) and the risk of poisoning, even if not all reported exposures are overdoses.
The victims of nicotine poisoning are not only vape. Nicotine poisoning from accidental exposures to vape fluid are also on the rise. In an article advising ER doctors on nicotine poisoning by vaping products, Emergency Physicians Monthly provides a hypothetical straight out of a parent’s nightmare:
EMS brings in a two-year-old with vomiting…. His parents say he was at a relative’s house when he was found drinking from a container of some colorful liquid, which he accidently spilled on himself. Then he began to vomit. The culprit: the liquid was used to refill electronic cigarettes.
Nicotine poisoning is clearly becoming a significant problem for vape users and those around them. In 2015, poison control centers received reports of 3,073 nicotine exposures by e-cigarette device and vape fluids. In many cases, these are unwary victims who could not have protected themselves, either from a product they (mistakenly) trusted as a “healthier alternative,” or from accidental exposure from the failure of dangerously defective and child-penetrable packaging.
What is Nicotine Poisoning?
Nicotine poisoning typically (but not always) occurs in two “phases:” an “early” phase followed quickly by a “late” phase. However, it is notable that some victims only exhibit late phase effects.
Early phase symptoms develop within the first 15 minutes – 1 hour: Vomiting is the most common symptom. Late phase symptoms occur within 30 minutes – 4 hours. The duration of these symptoms are about 1 – 2 hours following mild exposure, and up to 18 – 24 hours following a severe exposure.
And after a severe exposure, particularly if proper treatment is not administered, death may occur within 1 hour. Death is typically a result of paralysis of muscles that control breathing, a fluid buildup in the airways (“bronchorrhea”), and heart failure (“cardiovascular collapse”).
Mild poisoning can cause nausea, vomiting, dizziness and tremors. But more severe poisoning can cause life-threatening seizures, involuntary twitching, slowing of the heart rate and paralysis, particularly in children who are more sensitive to smaller doses of the chemical. The lethal dose of nicotine is still scientifically uncertain, but some studies estimate ~30-60 mg will kill an adult (only ~10 mg for a child).
Treatment for nicotine poisoning consists of multiple doses of activated charcoal, because activated charcoal effectively binds to the nicotine molecules in the body so they can be eliminated. Respirations should be supported by intubation and mechanical ventilation as needed.
In their 2015 E-Cigarette fact-sheet, CDC notes that nicotine is a known teratogen (a birth-defect inducing chemical) particular health danger for pregnant women and their developing fetuses. They recommend that in general pregnant women should not use e-cigarettes (or any tobacco product) because nicotine is toxic and impacts fetal brain and lung growth.
How are E-Cigarettes and Vape Fluids Causing Nicotine Poisoning?
Many nicotine poison control exposures, unsurprisingly, are a result of inhalation. In a forum for vape enthusiasts, entitled “Signs of Nicotine Overdose,” fellow vapers share and discuss their experiences with nicotine poisoning. There are currently 185 posts in the forum.
One poster writes:
On a recent visit to my doctor’s office [after] discovering a resting pulse of 120 my doc was about to call an ambulance, until I lied and told him I had just drank a lot of expresso earlier…my pulse rate is still too high so playing it by ear…. also I have suffered practically all the symptoms listed above for nicotine overdose and never realized what was causing them.
The sheer number of stories such as these show that vapers are suffering these effects regularly. They may experience currently unknown long-term health-effects of chronic nicotine exposure (and repeated poisoning). The CDC notes that aside from birth defects, data “about nicotine as a carcinogen is inconclusive” at present and “other developmental toxicity or reproductive toxicity risks are [currently] unknown.”
Given the negative health effects presently known about nicotine, however, it is likely that additional long-term health effects of nicotine exposure and poisoning will be uncovered.
In addition to the risks exposure by inhalation pose, direct exposure to e-cigarette fluid may negatively effect your health. The liquid nicotine in vape juice is readily absorbed through the skin, which is a not a risk of other nicotine products (i.e. cigarettes). As a result, Nicotine exposures by vaping products are more likely to be reported as eye exposures (8.5%) and skin exposures (5.9%), versus cigarettes.
Poorly-designed, defective, or child-penetrable packaging may lead to accidental spills, or worse a child may be drawn to the bright, appealing packaging and drink the flavored liquid inside. Indeed, it is likely for this reason that children younger than 6 represent more than half of reported exposures, according to the CDC.
Still, simple accidents are also possible as a result of poorly designed vape-fluid packaging: For example, if the small bottle is mistaken for eyedrops, which can be an easy mistake to make in a pocket or handbag, the fluid can cause eye injuries, including globe ruptures.
What Do You Do If You Are Exposed?
If you or a loved one are exposed to a source of nicotine, such as an e-cigarette fluid, the CDC recommends the following steps to provide care while seeking any needed medical attention:
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If you or a loved one has had injuries, or loss, as a result of an accidental nicotine poisoning resulting from vaping, vape fluids, or other e-cigarette products, you may deserve compensation for the pain and suffering you, or your loved ones, have experienced.
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