Electronic cigarettes: Difference between revisions

Revision as of 19:24, 11 June 2014

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
Nicotine usually suspended in a propylene glycol or vegetable glycerin solution (labeled as %PG/%VG)^[1]
Increasing toxic exposure to e-cigarettes
From Sept 2010 - Feb 2014, there were 16,248 toxic exposures to traditional cigarettes and 2,405 toxic exposures to e-cigarettes^[2]
Exposures to e-cigarettes increased from 1/month to 215/month over that time period

- 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.

Fatal intoxications are rare and estimates suggest 60mg as a lethal dose. Traditional cigarettes deliver approximately 2mg of icotine ^[3]

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

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

↑ 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

Authors:

@@ Line 16: / Line 16: @@
 *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>
 ===Absorption===
-**Absorbed transdermally, orally and via inhalation
+*Absorbed transdermally, orally and via inhalation
 ===Biphasic presentation===
-**Initially excitation secondary to excitation of the presynaptic nAChR which facilitates release of neurotransmitters
+*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
+*Second phase characterized by desensitization of the receptors and decreased neurotransmitter release
 ==Clinical Features==