As the popularity of electronic cigarettes has soared, so too have the number of liquid nicotine poisoning calls to the Washington Poison Center.
As of Nov. 11, the poison center has received 154 calls regarding liquid nicotine exposure this year. That’s more than double the total number of calls made in 2013, when liquid nicotine poisoning calls spiked after three years of fewer than 20 calls.
“E-cigarettes are one of the few products that we’re following that’s increasing dramatically,” said Dr. Alexander Garrard, a toxicologist and clinical managing director of the state poison center.
Local hospitals say they haven’t seen any notable increase in the number of people reporting to emergency departments with symptoms of nicotine exposure, but the poison center has recorded three cases of e-cigarette exposure in Clark County so far this year. Last year, the center received four calls from Clark County residents.
Reporting exposures to the Washington Poison Center is voluntary. Garrard is confident the actual number of liquid nicotine exposures is higher than what’s reported.
“We know they are higher,” he said. “It’s just a matter of how much.”
E-cigarettes are battery-powered devices that vaporize liquid nicotine, which is toxic. The nicotine in the e-cigarette cartridges is highly concentrated, making them even more concerning, Garrard said.
The concentrated liquid can contain as much as 24 milligrams of nicotine per milliliter. One e-cigarette chamber can hold 3 milliliters of liquid, which, with the highest concentration of nicotine, has the nicotine equivalent of eight or nine cigarettes, Garrard said.
A person with nicotine poisoning can experience a range of symptoms, from nausea and vomiting to increased heart rate and high blood pressure. In severe cases, the person can experience seizures, coma and death, Garrard said.
Nicotine exposures
E-cigarette or liquid nicotine exposure is defined as anytime an adult or child ingests, inhales, absorbs or injects the drug. An exposure does not necessarily mean the person will show symptoms, Garrard said. The main reason for calls to the poison center in Washington — for both adults and children — is for ingestion of the liquid nicotine of e-cigarettes.
In many cases involving children, the e-cigarette or its nicotine cartridges have been left out on a counter and a child gets a hold of them.
One example, Garrard said, is a child finds the device, starts playing with it and squirts nicotine on his hands. The child then puts his hands in his mouth or rubs his eyes. Now, the nicotine has been ingested by the child and may have also been absorbed through the skin.
The liquid nicotine is packaged in such a way as to be attractive to kids, he said. It comes in colorful packages with names such as “Rad Berry.” The nicotine can also be brightly colored and smell good.
“They can see it and think it looks a lot like candy,” he said.
Of the 154 calls to the poison center this year, 109 calls have been for exposures in children. The majority of those (91 cases) are among kids ages 1 to 3, Garrard said.
“For the past several years, every year, the pediatric exposures have at least doubled,” he said. “It’s this exponential increase.”
Exposures among adults come in a variety of ways, Garrard said.
One person collapsed and had a seizure after sampling several flavors of nicotine at a shop selling the devices. Another person mistook the nicotine cartridge on their nightstand for eye drops and inadvertently put drops of liquid nicotine in their eye, Garrard said.
Garrard encourages anyone who suspects they’re experiencing liquid nicotine toxicity, or anyone who finds a child with an e-cigarette device or cartridge, to contact the poison control center, which operates a confidential hotline 24 hours a day. The hotline is 800-222-1222.
Poison center staff, who are all experts in toxicology, recommend treatment to callers based on each situation. That treatment could range from washing hands with soap and water to seeking care at a hospital, Garrard said. So far this year, poison center staff have advised 56 people to go to the hospital after being exposed to liquid nicotine.
Garrard also recommends keeping the devices out of the reach of young children.
“If you treat it as if it’s a prescription medication — you would never keep an antidepressant pill or hypertension pill out on the counter — if you treat this product the same way, this will drastically reduce the number of exposures across the state,” he said.
