Pediatric death after unintentional exposure to liquid nicotine for an electronic cigarette

Eggleston, William; Nacca, Nicholas; Stork, Christine M.; Marraffa, Jeanna M.

doi:10.1080/15563650.2016.1207081

Cited by 20 publications

(16 citation statements)

References 7 publications

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“…Despite the high toxicity of nicotine, most of exposed children in our study were asymptomatic or developed only mild symptoms, typically nausea, a burning feeling in the mouth, salivation, vomiting and headache, with PSS 1 at the time of consultation. These observations corresponded to data from previous studies . This issue may be explained by the relatively high proportion of reports of suspected exposure, minimal exposure (licking) and quick intervention of parents to prevent serious exposure.…”

Section: Discussionsupporting

confidence: 88%

Acute exposures to e‐cigarettes and heat‐not‐burn products reported to the Czech Toxicological Information Centre over a 7‐year period (2012‐2018)

Obertova

Navrátil

Zak

et al. 2020

Basic Clin Pharma Tox

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E‐cigarettes and heat‐not‐burn cigarettes (HNBC) present new health risks due to their rising popularity, high content of nicotine and serious adverse effects. The objective of the study was to analyse the cases of acute exposure to e‐cigarettes, e‐liquids and HNBC products containing nicotine that led to toxicological consultations at our poisons control centre during a 7‐year period (2012‐2018) and identify the categories of special concern that require further investigation and intervention. The demographic, toxicological and clinical data were analysed by descriptive statistics. Poisoning severity score (PSS) was estimated. From 119 229 consultations, 148 cases concerned acute exposure to e‐cigarettes. Children and adolescents were exposed in 91 (61%) cases, including exposure of neonates and infants in 54 (36%) cases. The main route of exposure was ingestion in 129 (87%), inhalation in nine (6%), ocular in six (4%) and intravenous administration in three (2%) cases. The source of exposure was the cartridge with e‐liquid (107; 72%), refillable tank in 29 (20%) and HNBC refill in nine (6%) cases. The reason for exposure was accidental in 110 (74%), incorrect application of the device in 10 (7%), abuse in six (4%), suicide attempt in six (4%) and other/unknown in 16 (11%) cases. The dose estimation was severe/lethal in 6 (4%), toxic in 53 (36%), low‐to‐moderate in 35 (24%) and unknown in 54 (36%) cases. Vomiting was observed in 38 (26%) patients; 72% of patients were hospitalised. In symptomatic cases, 41 patient had PSS 1, 12 patients had PSS 2, and one patient had PSS 3. Activated charcoal was applied in 57 (39%) patients, and symptomatic treatment was recommended in 75 (51%) patients. Cases of unintentional exposure of children demonstrate the need for preventive risk reduction measures.

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Section: Discussionsupporting

confidence: 88%

Acute exposures to e‐cigarettes and heat‐not‐burn products reported to the Czech Toxicological Information Centre over a 7‐year period (2012‐2018)

Obertova

Navrátil

Zak

et al. 2020

Basic Clin Pharma Tox

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“…Current knowledge of e-cigarette exposures and their associated toxicity is based on case reports, small case series, and retrospective poison center data [2,3,7,[9][10][11]. Several published reports have described e-cigarette exposures causing topical irritation [8,12], GI symptoms [5,7,13,14], myocardial infarction [15], and severe nicotine toxicity manifesting as respiratory arrest [1,7,16], and even death [16][17][18][19][20][21]. Prior reports from US poison centers indicates that a large proportion of calls involve children, especially those younger than 5 years of age [2,22,23].…”

Section: Discussionmentioning

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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“…Poisonings were caused by accidental (9/28) [138][139][140][141][142][143][144][145][146] Accidental ingestion was observed only to young children with a median age of 2 years old (IQR: 0.85-4) and mainly to females (6/8). Information on sex was not available for 1 case.…”

Section: Poisoningmentioning

confidence: 99%

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

Tzortzi

Kapetanstrataki

Evangelopoulou

et al. 2020

IJERPH

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Following the recent electronic cigarette (e-cigarette) illness outbreak, the current review aimed to collect all related clinical cases for study and analysis and provide a critical synopsis of the proposed injury mechanism. Adhering to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis) guidelines, e-cigarette-related clinical cases were identified via Google Scholar and PubMed databases. Additionally, references of published case reports and previous review papers were manually searched, revealing 159 publications presenting e-cigarette-related case reports and 19 reports by the Centers for Disease Control and Prevention. 238 individual cases were identified; 53% traumatic injuries due to e-cigarette explosion or self-combustion, 24% respiratory cases, and 12% poisonings. Additional cases pertained to oral, cardiovascular, immunologic, hematologic, allergic reactions, infant complications, and altered medication levels. Case reports were mainly published between 2016–2019 (78%). The oldest case, a lipoid pneumonia, was published in 2012. The current review showed that e-cigarette-related health effects extend beyond the acute lung injury syndrome, including traumatic, thermal injuries and acute intoxications. Physicians should be aware of the distinct clinical presentations and be trained to respond and treat effectively. Regulators and public health authorities should address the regulatory gap regarding electronic nicotine delivery systems (ENDS) and novel tobacco products.

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Pediatric death after unintentional exposure to liquid nicotine for an electronic cigarette

Cited by 20 publications

References 7 publications

Acute exposures to e‐cigarettes and heat‐not‐burn products reported to the Czech Toxicological Information Centre over a 7‐year period (2012‐2018)

Acute exposures to e‐cigarettes and heat‐not‐burn products reported to the Czech Toxicological Information Centre over a 7‐year period (2012‐2018)

An epidemiologic and clinical description of e-cigarette toxicity

A Systematic Literature Review of E-Cigarette-Related Illness and Injury: Not Just for the Respirologist

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