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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