I. See Also
- Nicotine Replacement
- Tobacco abuse
II. Mechanism
- Battery powered electronic device vaporizes a concentrated nicotine liquid in a replaceable cartridge
- User inhales nicotine vapor
- Various nicotine preparations are sold and not regulated
- Some nicotine solutions are flavored or colored (attracting young children)
III. Precautions
- Not recommended as Nicotine Replacement
- NOT a Nicotine Replacement device (unlike Nicotine Patch, Nicotine Gum)
- New, inventive way for companies (several that market Tobacco) to market an unregulated (in 2014), addictive nicotine product
- E-Cigarette has had a recent increase in use among U.S. high school students
- Nicotine solutions are not regulated and their labels may be inaccurate and their contents contaminated
- Inadequate safety data available for these devices and the inhaled vapor compared other Nicotine Replacement forms
IV. Adverse Effects: Nicotine toxicity
- Nicotine solution is sold in large refillable 100 mg bottles
- Nicotine solutions are highly concentrated (up to 100 mg/ml)
- The solution is well absorbed by the gastrointestinal tract
- Toxicity risk is high when ingested by young children
- Toddlers experience symptoms with 1 mg ingestion
- Lethal dose at 6-13 mg/kg
- Nicotine has a Succinylcholine-like stimulatory effect on nicotinic receptors
- Results in Seizures followed by paralysis
V. Signs: Toxic Ingestion (children)
VI. Management: Toxic ingestion (children)
-
Seizures
- Treat with Benzodiazepines
- See Status Epilepticus
- Paralysis or fasciculations
- Intubate under Rocuronium (avoid Succinylcholine)
- Post-intubation Sedation with Benzodiazepines
VII. Resources
- Electronic nicotine delivery systems: is there a need for regulation?
VIII. References
- (2014) Presc Lett 21(6): 36
- Swadron and Nordt in Herbert (2014) EM:Rap 14(6): 14
- Vardavas (2012) Chest 141(6):1400-6 [PubMed]
- Trtchounian (2011) Tob Control 20:47-52 [PubMed]
