December 10, 2013
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. The Kentucky Regional Poison Control Center of Kosair Children's Hospital has received 39 calls about e-cigarettes so far this year, a 333% increase from nine calls received in 2012. Nationally, poison control centers have seen a 161% 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, 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 George Rodgers, M.D., 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. 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 LaQuandra Nesbitt, M.D., 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 Stephen P. Wright, M.D., 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 Dr. 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."
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