Liquid-nicotine poisoning in kids could be on the rise, doctors warn

By Rob Goodier

NEW YORK (Reuters Health) - Refill cartridges full of nicotine solution for e-cigarettes may be a growing accidental-poisoning threat for children, researchers say.

E-cigarette-liquid-related calls to poison centers have spiked from one in September 2010 to 215 in February 2014 and slightly more than half of those involved children younger than five years old, they write in a letter in Archives of Disease in Childhood, online September 8.

There have not yet been any deaths, however, Dr. Sanjay Gupta, a pediatrician at Good Hope Hospital in Birmingham, UK, and colleagues note.

After seeing a 30-month-old girl with a history of accidental ingestion of nicotine solution, the team searched Toxbase but found no information on nicotine-liquid poisonings.

The child was systemically well and all clinical observations were normal. She was observed for six hours and then sent home. Meanwhile, there are a few things that emergency department staff should keep in mind, Dr. Gupta said.

"The emergency room doctors need to be aware that the e-cigarette nicotine liquid is available in many strengths, from 6mg/ml to 36 mg/ml. When dealing with such cases they should specifically inquire about the strength," he told Reuters Health by email.

In adults, a lethal dose of nicotine may be 40mg, the researchers write. Extrapolating from that, a lethal dose in children may be as little as 1mg/kg of the child's weight.

Children who have swallowed 0.2mg/kg and have symptoms should see a doctor, the researchers write.

Symptoms include burning in the mouth and throat, nausea, vomiting, dizziness, hypersalivation and others. Medical signs include tachycardia, tachypnea and hypertension followed by bradycardia, hypotension and respiratory depression. Severe poisoning can cause arrhythmias, coma, convulsions and cardiac arrest, the researchers write.

Parents can prevent poisonings at home and they might consider storing liquid nicotine cartridges in a child-proof container, Dr. Gupta said.

"Parents should treat liquid-nicotine cartridges and devices as potentially harmful substances and keep them safe out of reach of children (similar to other medication, alcohol and other harmful substances)," he said.

SOURCE: http://bit.ly/1qQFgdE

Arch Dis Child 2014.

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