E-cigarette (vaping) use has become increasingly popular over the past 10 years, especially among adolescents. Intentional exposure (i.e. ingestion in self harm) of nicotine (e-cigarette liquid) can be life threatening where it can produce mixture of stimulatory (early), cholinergic toxicity and muscle paralysis/respiratory failure by blocking the neuromuscular junction. However, the severity of clinical toxicity in unintentional exposure can vary widely depending on the dose/route/circumstance of their exposure.

A recently published study investigated the characteristics of e-cigarette liquid exposure between Jan 1, 2010 to Dec 31, 2018 using the National Poison Data System

Result

• Total reported exposure: 17,358.
• e-cigarette exposure report increased starting 2013 (n=1435), peaking in 2014 (3742). 2018 (n=2901).

Top 4 clinical/demographic characteristics are listed below.

Age group:

• < 5 years: 64.8%
• 25+ years: 15.4%
• 18-24 years: 8.3%
• 12-17 year: 3.4%

Route of exposure

• Ingestion: 77.5%
• Dermal: 13.0%
• Inhalation/nasal: 10.4%
• Ocular: 7.1% 

Level of care:

• Not referred to health care facility (HCF): 60.9%
• Treated and released from HCF: 27.4%
• Admitted: non-critical care: 0.8%, critical care: 0.6%

Clinical effects - overall

• Vomiting: 25.4%
• Nausea: 11.8%
• Ocular irritation: 11.3%
• Dizziness/vertigo: 5.1%

In <5 years group

• Vomiting: 47.1%
• Cough/choking: 10.2%
• Drowsiness/lethargy: 5.7%
• Nausea: 5.5%

Conclusion

• e-cigarette exposure predominantly occurs in young children (< 5 y/o)
• Clinical toxicity are usually self-limited and often not referred to HCF.
• Severe toxicity is possible, although infrequent, from unintentional exposure.

References

Poisoning exposure cases involving e-cigarettes and e-liquid in the United States, 2010-2018.