Electronic cigarettes: Difference between revisions
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==Background== | ==Background== | ||
*Nicotine containing products that are currently not regulated by the FDA | *Nicotine containing products that are currently not regulated by the FDA | ||
*On 4/25/14, the FDA proposed legislation to allow them to regulate e-cigarettes like other tobacco products | *On 4/25/14, the FDA proposed legislation to allow them to regulate e-cigarettes like other tobacco products<ref>Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act [https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-09491.pdf PDF]</ref> | ||
*Nicotine usually suspended in a propylene glycol or vegetable glycerin solution (labeled as %PG/%VG)<ref>Carmines EL, Gaworski CL. Toxicological evaluation of glycerin as a cigarette ingredient. Food Chem Toxicol. 2005 Oct;43(10):1521-39</ref> | *Nicotine usually suspended in a propylene glycol or vegetable glycerin solution (labeled as %PG/%VG)<ref>PG e-liquid, VG e-liquid or PG/VG Mix e-liqud? http://www.bestecig.com/help.asp?id=57</ref><ref>Carmines EL, Gaworski CL. Toxicological evaluation of glycerin as a cigarette ingredient. Food Chem Toxicol. 2005 Oct;43(10):1521-39</ref> | ||
*From Sept 2010 - Feb 2014, there were 16,248 toxic exposures to traditional cigarettes and 2,405 toxic exposures to e-cigarettes<ref>CDC reports. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm</ref> | *From Sept 2010 - Feb 2014, there were 16,248 toxic exposures to traditional cigarettes and 2,405 toxic exposures to e-cigarettes<ref>CDC reports. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm</ref> | ||
*Exposures to e-cigarettes increased from 1/month to 215/month over that time period | *Exposures to e-cigarettes increased from 1/month to 215/month over that time period | ||
===Product Types=== | ===Product Types=== | ||
*Some are fixed products with no refill capabilities (Ex. Blu e-cigarettes) while others can be refilled with replacement nicotine fluid | |||
*Common strengths include 6mg/ml (low), 12mg/ml (medium-low), 18mg/ml (medium), 24mg/ml (high) and 36mg/ml (Ultra-high) | *Common strengths include 6mg/ml (low), 12mg/ml (medium-low), 18mg/ml (medium), 24mg/ml (high) and 36mg/ml (Ultra-high) | ||
*Common refill sizes range from 5ml to 30ml | *Common refill sizes range from 5ml to 30ml | ||
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==Pathophysiology== | ==Pathophysiology== | ||
*Fatal intoxications are rare and estimates suggest 60mg as a lethal dose. Traditional cigarettes deliver approximately 2mg of icotine <ref>Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol. 2014; 88: 5–7</ref> | *Fatal intoxications are rare and estimates suggest 60mg - 500mg as a lethal dose. Traditional cigarettes deliver approximately 2mg of icotine <ref>Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol. 2014; 88: 5–7</ref> | ||
===Absorption=== | ===Absorption=== | ||
*Absorbed transdermally, orally and via inhalation | *Absorbed transdermally, orally and via inhalation | ||
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==Source== | ==Source== | ||
<references/> | <references/> | ||
[[Category:Tox]] | [[Category:Tox]] | ||
Revision as of 01:42, 12 June 2014
Background
- Nicotine containing products that are currently not regulated by the FDA
- On 4/25/14, the FDA proposed legislation to allow them to regulate e-cigarettes like other tobacco products[1]
- Nicotine usually suspended in a propylene glycol or vegetable glycerin solution (labeled as %PG/%VG)[2][3]
- From Sept 2010 - Feb 2014, there were 16,248 toxic exposures to traditional cigarettes and 2,405 toxic exposures to e-cigarettes[4]
- Exposures to e-cigarettes increased from 1/month to 215/month over that time period
Product Types
- Some are fixed products with no refill capabilities (Ex. Blu e-cigarettes) while others can be refilled with replacement nicotine fluid
- Common strengths include 6mg/ml (low), 12mg/ml (medium-low), 18mg/ml (medium), 24mg/ml (high) and 36mg/ml (Ultra-high)
- Common refill sizes range from 5ml to 30ml
- Products come in a variety of flavors that can be enticing to children
- Bubble gum, root beer, extreme soda, Ecto-cooler, Banana cream pie, toasted marshmallow, etc.
Pathophysiology
- Fatal intoxications are rare and estimates suggest 60mg - 500mg as a lethal dose. Traditional cigarettes deliver approximately 2mg of icotine [5]
Absorption
- Absorbed transdermally, orally and via inhalation
Biphasic presentation
- Initially excitation secondary to excitation of the presynaptic nAChR which facilitates release of neurotransmitters
- Second phase characterized by desensitization of the receptors and decreased neurotransmitter release
Clinical Features
- Highly variable presentation
- Tobacco is a GI irritant and often causes spontaneous vomiting
- Biphasic presentation
- Initially present with excitation, N/V/D, salivation, tachycardia, hypertension, diaphoresis
- Delayed presentation is hypotension, bradycardia, hypoventilation, fasiculations, seizures, coma, death
Diagnosis
- Exposure to nicotine containing liquid
- Toxidrome similar to nicotinism
Work-Up
- CBC
- Chem 7
- Utox
Differential Diagnosis
- Anticholinergic Toxicity
- Organophosphate Toxicity
- Sympathomimetic Toxicity
- Neuroleptic Malignant Syndrome (NMS)
- Serotonin Syndrome
- Sepsis
Treatment
- Decontamination
- Activated charcoal
- Wear proper PPE
Symptoms guide treatment
- Atropine - Bradycardia
- Fluids - Hypotension
- Benzos - Seizures
- Intubation/PPV - Respiratory failure
Disposition
- Admit for symptomatic poisonings
See Also
Source
- ↑ Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act PDF
- ↑ PG e-liquid, VG e-liquid or PG/VG Mix e-liqud? http://www.bestecig.com/help.asp?id=57
- ↑ Carmines EL, Gaworski CL. Toxicological evaluation of glycerin as a cigarette ingredient. Food Chem Toxicol. 2005 Oct;43(10):1521-39
- ↑ CDC reports. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm
- ↑ Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol. 2014; 88: 5–7