A case of nicotine poisoning from e-liquid (?)

Comment by Dr Konstantinos Farsalinos

Few hours ago, a story about the death of a 2 year-old child from acute nicotine intoxication has been reported. The report of an Israeli newspaper states that the child ingested e-liquid, and that this was the cause of death.

As expected, this report generated a lot of concern in the vaping community. In case the story is true, I think it is something that most of us were sure it would happen. Don’t we know that nicotine is toxic? Don’t we know that each e-liquid bottle has enough nicotine to kill more than one adult, let alone a child? Do we expect that the millions of users all over the world are all sufficiently educated about how e-liquid bottles should be handled? Do we expect that all manufacturers provide child-proof bottles?

Nicotine is highly toxic through skin contact, but probably higher levels are needed when ingested. For example, in rats the lethal dose is 5 times higher when ingested compared to when administered intravenously. Moreover, nicotine has a bitter taste; it is highly unlikely that someone likes the taste (even when flavored). I do not know of any case report of children deaths from ingesting tobacco products, although some case reports of intoxication by ingestion have been reported (all children survived). A document by RJ Reynolds reported that, according to data from the American Association of Poison Control Center, from 1996 to 2007 there have been 97,000 reports of accidental ingestion of tobacco products (87% children), and only 5 deaths (one death of a child, ingesting nicotine butts).

I know that vapers are concerned because public health authorities will probably release a relentless attack on e-cigarettes based on this accident. But, it is not the product that should be blamed. The irresponsible behavior of parents or child attendants should be blamed. We have seen deaths from cleaning products, cosmetics (48 deaths from 1996-2007), dietary supplements (70 deaths), NRTs (5 deaths) etc. None tried to implement a ban on these products.

Let’s see how this story unfolds, and let’s wait to see if it is really a case of e-liquid related death. In any case, this should be a lesson for everyone, to be responsible when handling nicotine-containing liquids. And manufacturers should use child-proof bottles and proper labeling for all these products. Children are our future, let’s hope we will not hear any other sad stories like that.



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0 #18 Allen Speck 2014-08-04 22:24
Has this story been verified? There was an initial flurry of media activity and I can find no follow-up report or information, which makes me a little suspicious.
0 #17 Phil 2014-05-17 17:06
:D Bruce Baldwin, ecigarettes are recommended by doctors and physcians alike. They are a lot healthier than regular cigarettes due to the 5000 odd chemicals found in them. Products like this have to be handled correctly and not banned as they are saving lives and not losing them. Wake up and educate yourself first before entering into a debate you obviously know nothing about.
0 #16 Willard 2014-02-24 20:04
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0 #15 Dr Farsalinos 2013-07-18 14:39
I have not seen any new reports for this incidence...
-1 #14 K. 2013-07-18 14:38
I heard on a radio talk that it was not e-liquid but nicotine gums the kid swallowed - do you have any updates on this?
+1 #13 Lane 2013-07-16 20:41
I have to admit, I've been leaving my liquids around the house & my 3 year old little could have easily gotten a hold of it. Not anymore. I'm new to vaping (3 weeks) & just learned about this while researching. I've bought liquids from 3 different vendors, 1 online & 2 local stores & there were never any warnings given. Vendors need to be warning their consumers. I've been smoking for over 20 years & I knew nicotine was toxic of course, but never realized it took so little to be fatal.
-2 #12 catherine.shawn 2013-07-11 02:59
This text on comments of e-cigars has given our manufacturer a truly reputation.
we product the specail cigars not for the neglectance to children.Instea d, we just considered ther health ang then creat the substance for real cigarette.Since the nicotines in it can be lagely reduced.Gradual ly,the user may have the opportunity of giving up smoking!!
+1 #11 Dr Farsalinos 2013-07-08 19:10
Since you have been a smoker, i am sure you know how difficult it was. The "just quit" sentence doew not work unfortunately.. .
-16 #10 bruce Baldwin 2013-07-08 18:10
Come on people - this is a perfect example of why this stuff should be illegal! It's DEADLY! 160- 180 mgs of nicotine constitute a lethal. Ask any ER doc if they've ever seen nicotine overdose and they'll fill you in, happens all the time when people smoke on the patch. You used to be able to purchase nicotine sulfate in liquid form (to KILL BUGS) but no longer as there is just no way to make it safe for home use. I smoked for 25 years, so I understand the need to justify your use, but wake up. You want freedom - QUIT, you'll be much happier.
0 #9 Dr Farsalinos 2013-06-05 21:34
Bill, although i agree with you that each cigareette contains a lot of nicotine (i would say 15-20mg, but your numbers may be right), it is true that most of the nicotine is destroyed by the heat of combustion. That is why only a small fraction is released in the smoke and inhaled (although it is still more than what the ISO protocol suggests).
The interesting thing, is that there have been cases of cigarette ingestion by children (thus, no combustion is involved, so all nicotine is avialable) without any case of death. I suppose you mean ingesting cigarette, not smoking one as you write.
The reason is probably related to the information i provided: "In rats the lethal dose is 5 times higher when ingested compared to when administered intravenously." Ingestion means that nicotine enters the venous system through the intestinal mucosa and first goes through the liver, where it is metabolized. On the contrary, inhalation delivers nicotine directly to the arterial circulation.

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