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CDC Study: Significant Increase in e-Cigarette Calls to Poison Centers

Apr 7, 2014

A new study conducted by the U.S. Centers for Disease Control and Prevention (CDC) reveals a significant increase in e-cigarette-related telephone calls to poison centers. According to the agency, the dramatic rise points to a need to monitor the exposure to nicotine by way of e-cigarette liquid so that future poisonings may be prevented.

The number of calls increased from one call monthly in September 2015 to 215 calls per month in February 2014, according to the CDC. Data was derived from the poison centers that serve the 50 states, the District of Columbia, and United State Territories and involved calls reporting exposure to conventional cigarettes, e-cigarettes, or the nicotine liquid used in e-cigarettes. Poison centers reported 2,405 e-cigarette and 16,248 cigarette exposure calls from September 2010 to February 2014.

The CDC reviewed total monthly poison center calls involving e-cigarettes and conventional cigarettes, and found e-cigarette calls increased from 0.3 percent to 41.7 percent at the start and end of the study period, respectively. Poisoning from conventional cigarettes typically occurs when young children eat cigarettes, while e-cigarette poisoning involves the nicotine-containing liquid that is used in the devices and occurs by ingestion, inhalation, skin or eye absorption. More than half—a total of 51.1 percent—of the calls made to poison centers involving e-cigarettes involved children under the age of five and 42 percent involved people age 20 and over, the CDC reported. The CDC pointed out that the number of monthly involving traditional cigarettes did not reflect a similar increase during the same time period.

The total number of poisoning cases is likelier greater than the study reflects as not all exposures might have been reported to poison centers, the CDC indicated. The study was just published in Morbidity and Mortality Weekly Report.

“This report raises another red flag about e-cigarettes—the liquid nicotine used in e-cigarettes can be hazardous,” said CDC Director Tom Frieden, M.D., M.P.H. “Use of these products is skyrocketing and these poisonings will continue. E-cigarette liquids, as currently sold, are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.” Following exposure, it was e-cigarettes that involved more adverse health effects including vomiting, nausea, and eye irritation, according to the CDC.

“The most recent National Youth Tobacco Survey showed e-cigarette use is growing fast, and now this report shows e-cigarette related poisonings are also increasing rapidly,” said Tim McAfee, M.D., M.P.H., Director of CDC’s Office on Smoking and Health. “Health care providers, e-cigarette companies and distributors, and the general public need to be aware of this potential health risk from e-cigarettes.”

Nicotine e-liquids are very strong stimulant neurotoxins that are sold in various sizes to consumers. Nicotine e-liquids are potent, extracted from tobacco, and sold in vial, gallon, and barrel sizes. The nicotine is made into a formulation with flavors, colors, and chemicals, according to a recent The New York Times report. An important ingredient in e-cigarettes, the liquid, even small amounts—ingested or absorbed—may lead to vomiting, seizures, and death. A teaspoon, writes the Times, is sufficient to kill a small child.

The public, wrote Forbes, is not aware of the toxicity of ingesting and skin absorption of nicotine, and associated symptoms. These include rapid heart beat, elevated blood pressure, nausea, vomiting, diarrhea, dizziness, confusion, and seizures leading to coma and death. More severe exposures may lead to low blood pressure and a low heart rate. e-liquids are considered significantly more toxic than tobacco as the liquid is more readily absorbed, even when diluted.

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