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Poisonings Skyrocket as Kids Ingest E-cigarette Nicotine Refills

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Poisonings Skyrocket as Kids Ingest E-cigarette Nicotine Refills

Sep 30, 2014

Refills for e-cigarettes that smell and taste sweet present a potentially fatal risk to children. Dr. Zane Horowitz from the Utah Poison Control Center deals with this increasingly common form of poisoning. These concentrated nicotine vials are currently unregulated and accidental poisonings are skyrocketing. He discusses symptoms, treatments and common-sense prevention.

Episode Transcript

Interviewer: You may think that e-cigarettes are safer than conventional cigarettes, but did you know that in 2014, poison control centers in the United States received up to 215 calls per month about e-cigarette poisoning? That's next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Interviewer: I'm talking with Dr. Zane Horowitz today. He's the Medical Director of the University of Utah Poison Control Center. Dr. Horowitz, I read something from the Center for Disease Control recently about the rise in poison control center calls regarding poisoning from e-cigarettes. What's that all about?

Dr. Horowitz: Well it's not so much the cigarettes themselves but the refillable cartridge where you put the liquid that you vape, in. Right now the amount of nicotine that's in that can vary dramatically. The flavors are tasty flavors that are attractive to kids, bubble gum, cherry, and all these fruity flavors. A few sips of that will deliver sometimes as much as anywhere from on the low side 10 milligrams of nicotine all the way up to 200 to 400 milligrams of nicotine. To put that in perspective, when we smoke a single cigarette, that delivers about 1 milligram of nicotine.

So a child who accidentally takes the top off this and smells it and it smells nice and fruity, and tastes it and it tastes really delicious, and takes a gulp or two, he's getting the equivalent of maybe 200 or more cigarettes delivered all at once. And he's going to get quite sick. The poison centers nationwide and here in Utah have been receiving increasing number of calls as these products have grown on the market. People are having these out on the kitchen table and the coffee table in the living room, so children just reach over. A sip later, and all of a sudden they're vomiting and they're sick and they have to go into the emergency room to be treated.

Interviewer: I guess maybe we need to go back and talk a little bit about e-cigarettes to begin with. Tell me what an e-cigarette is and how a person uses it.

Dr. Horowitz: The "e" stands for electronic. They're made to look a lot of times like cigarettes or cigars, although sometimes they're made to look like other objects. There's a long chamber where you can put a liquid, and the liquid contains mostly nicotine, but it could be flavored and there could be other things in it as well. There's a little heater that warms that up and creates a vapor. You inhale it just like a cigarette and you just get the vapor of nicotine without all that other smoke, all that burning tobacco leaves stuff that makes you smell like an ashtray. So it's reasonably odorless, although they tend to have a fruity odor about them. When that portion gets burned up, you take a refill out of your pocket or wherever you have it and you fill up that little chamber again so you can keep on vaping, is the term.

Interviewer: Recently the CDC put out a report that stated that back in 2010, poison control centers were getting about one call per month on e-cigarettes. In 2014, they're getting as many as 215 calls per month. That's a pretty astounding jump, don't you think?

Dr. Horowitz: Right. It's been rising almost every month, month to month, as more and more of these products are sold and they're in people's homes and they're where children are. Currently because there isn't any regulation one way or the other, how much is in these liquids is unknown. There's no safety cap as there would be with a medicine bottle or an automotive product. Other consumer products that we have around the house that we know can be dangerous to children often have some sort of cap that the child can't take off easily. And it's usually the exploratory 1 or 2 year old child who's learning how to manipulate things and pulls it off that and it smells delicious and they stick in their mouth and it tastes delicious and they drink a gulp. It doesn't take much with this. That's probably the key point. One gulp can be quite toxic to children.

Interviewer: And you're talking specifically about the flavored liquid that goes inside of these e-cigarettes.

Dr. Horowitz: Right.

Interviewer: What do the containers look like?

Dr. Horowitz: They look like a little eye dropper bottle. So far there aren't giant companies making these yet, so a lot of these are home grown little stores. They buy a little plastic bottle with a little screw top on it and you pour that little screw top or an eye dropper full into your chamber of your e-cigarette and put the cap back on. It doesn't take more than a quarter turn twist to get the cap back off, and that's easy for a child of 1 or 2 years old to manipulate and they have access to it.

Interviewer: The CDC Director, Tom Frieden, actually mentioned that these e-cigarette liquids are not required to be childproof.

Dr. Horowitz: Right now there isn't any regulation about that. That's being considered. I think we have to take a very rational common-sense approach to it. The simplest thing is obviously make these things childproof like we've made medicine bottles, automotive products, and some household cleaners that are toxic. That's the first big thing. Then I think the number of exposures will go down.

The second thing is just educating parents and uncles and aunts and whoever else is going to be visiting with little children, use some common sense. Don't put this out on the table and have your 2-year-old watch you pull it out and spill it in your little chamber of the e-cigarette and sit there vaping. They'll all look at it and go, "Wow. That looks like a cool little toy that I can play with now." Then you put it back on the counter or the table and they're going to take it apart and try to figure it out for themselves because that's what kids do.

Interviewer: If a child ingests this, what do some of the symptoms look like?

Dr. Horowitz: Usually they have nausea and vomiting. Sometimes they vomit over and over and over again. They can get pretty dehydrated pretty quickly for a small child. But in large amounts, like I said those concentrations sometimes can be equal to 200 cigarettes, this could potentially be fatal. A child could die if he takes those really concentrated liquids, and some stores are selling those, the high concentration, meant to be diluted down by the person who's going to be vaping. If a child gets into a few gulps of that, they can have seizures. They can have heart arrhythmias, where their heart beats very irregularly, and in severe cases, if they took enough of that, they could die.

Most of the things we're seeing are the lower concentrations, but there's no labeling. We don't know how much is in any product, and the size of these can vary from a tiny little dropper size to something that looks like a soda bottle size.

Interviewer: How long does it take for some of these symptoms to appear?

Dr. Horowitz: Usually pretty quickly, usually within minutes. Usually within five or ten minutes we're going to see something. The child is going to start vomiting and sweating and feeling pretty miserable.

Interviewer: Let's say they get a really heavy dose, one of these that could be fatal. How long does the child have to get treatment before they die?

Dr. Horowitz: Well if someone accidentally drank one of these with a high concentration, we would probably advise parents to call 911 and have an ambulance drive them to the hospital.

Interviewer: With a lower dose poisoning, do you still recommend that parents take their children into the emergency room, or what do you suggest to them?

Dr. Horowitz: Well I think if there's an accidental little taste or a lick, they certainly can call the poison center 24 hours a day. We have nurses and pharmacists with training, we've briefed everybody on this, and they can talk through the particulars of each individual occurrence. So if it's a small amount and the child's not having immediate nausea and vomiting, we may not have to send you to the hospital or the doctor. We'll just sort of call you back and see how you're doing.

Interviewer: Can you just tell us the number to the Poison Control Center for parents that might be interested to know that?

Dr. Horowitz: Yes. It's a universal 800 number. In whatever state you are in it will get you to your state's poison center. It's 1-800-222-1222. 24 hours a day that phone will be answered live by our poison information specialists and they're very happy to talk to you. No question's too small, whether it's e-cigarettes or any other product that your child might get into at home.

Interviewer: All right. Thank you.