E-Cigarettes Rising Cause of Nicotine Poisoning in Children

Nicola M. Parry, DVM

May 09, 2016

With the rise in popularity of electronic cigarettes (e-cigarettes), the number of children at risk for nicotine poisoning associated with these products has increased significantly in recent years, a new study suggests.

"The frequency of exposures to e-cigarettes and nicotine liquid among young children reported to US [Poison Control Centers] is rising rapidly," write Alisha Kamboj, BS, from the Ohio State University College of Medicine, Columbus, and colleagues. "Children exposed to e-cigarette devices and nicotine liquid are >2.5 times more likely to have a severe outcome than children exposed to cigarettes, and lethal exposure has occurred."

The authors published the results of their study online May 9 in Pediatrics.

The use of e-cigarettes has substantially increased since they first entered the US marketplace in 2007. In particular, e-cigarette use tripled among high school students from 2013 to 2014. In addition, previous studies have shown that calls to US Poison Control Centers related to e-cigarette exposures have also increased substantially, with more than half of these exposures in children younger than 6 years.

To better understand the risk for exposures in young children, Kamboj and colleagues conducted a retrospective study of data from the National Poison Data System. Specifically, they examined data for single substance exposures involving nicotine and tobacco products from January 2012 through April 2015 among children younger than 6 years.

During this period, the National Poison Data System received 29,141 calls related to these exposures in children in this age group, averaging 729 calls per month. E-cigarette exposure accounted for 14.2% of these exposures, cigarettes accounted for 60.1%, and other tobacco products accounted for 16.4%.

However, the monthly number of e-cigarette exposures in children increased significantly (P = .04) by 1492.9% during the study, from 14 in January 2012 to 223 in April 2015. Meanwhile, the monthly number of cigarette exposures (P = .08) and of other noncigarette tobacco product exposures (P = .18) remained the same.

Children younger than 2 years accounted for 79.6% of all exposures, 44.1% of e-cigarette exposures, 91.6% of cigarette exposures, and 75.4% of other tobacco exposures.

Although 35.8% of children who were exposed to nicotine or tobacco products experienced no clinical effects, 1.2% suffered severe outcomes.

In particular, children who were exposed to e-cigarettes had 5.2 times higher odds (odds ratio [OR], 5.19; 95% confidence interval [CI], 3.60 - 7.48) of hospitalization and 2.6 times higher odds (OR, 2.60; 95% CI, 1.96 - 3.46) of severe medical outcomes than those who were exposed to cigarettes.

Serious clinical effects occurred among children younger than 3 years and included asystole/cardiac arrest (n = 1), coma (n = 6), single seizure (n = 6), and respiratory arrest (n = 3). The asystole/cardiac arrest occurred in a 1-year-old child who drank nicotine liquid from an open refill container and resulted in the child's death.

The authors note that the most common routes associated with e-cigarette exposure were ingestion alone (81.5%), multiple routes with ingestion (9.7%), dermal (3.3%), and inhalation/nasal (3.2%). They stress that young children are susceptible to accidental ingestion of these products because of their natural curiosity and tendency for oral exploration. Children might be especially attracted to the colorful packaging, candy-like appearance, and added flavorings associated with e-cigarettes and their refill products. In addition, a lack of regulation and quality control increases the risk for toxic exposure because of inconsistent nicotine concentrations in these products.

Last week, the US Food and Drug Administration announced new rules allowing it to regulate e-cigarettes and other tobacco products not previously under their oversight. The rules also make it illegal for retail outlets to sell e-cigarettes to minors.

Kamboj received financial support from the National Student Injury Research Training Program at Nationwide Children's Hospital, funded by the Centers for Disease Control and Prevention, and the Child Injury Prevention Alliance. The other coauthors have disclosed no relevant financial relationships.

Pediatrics. Published online May 9, 2016. Abstract

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