A New Source for Nicotine Exposures in Pediatric Patients: Electronic Cigarettes

Introduction:
This text discusses the emergence of electronic cigarettes (e-cigarettes) as a significant source of nicotine exposure in pediatric patients. It highlights the risks associated with e-cigarettes, particularly the liquid nicotine refill bottles, and the lack of regulation regarding packaging and labeling of e-cigarette liquid nicotine. The article also provides information on the clinical management of nicotine toxicity and the symptoms of nicotine poisoning.

Key Points:

* E-cigarettes have gained popularity in recent years, leading to an increase in nicotine exposures.
* Liquid nicotine refill bottles for e-cigarettes contain high concentrations of nicotine (0.6% to 2.4%) and are not packaged in child-resistant containers.
* The estimated fatal dose of nicotine for a 10-kg child is 60 mg, but as little as a few drops of e-cigarette liquid nicotine can cause symptoms.
* The Food and Drug Administration has no regulations regarding packaging or labeling of e-cigarette liquid nicotine.
* Clinical management for nicotine toxicity is largely symptomatic and supportive, and activated charcoal can be considered for asymptomatic children who have ingested e-cigarette liquid nicotine.
* Nicotine poisoning typically occurs in two phases, with early symptoms including tachycardia, elevated blood pressure, and nausea/vomiting.
* Late symptoms of toxicity include bradycardia, hypotension, lethargy, and neuromuscular blockade.
* Exposed skin should be washed thoroughly with soap and water to prevent dermal absorption of nicotine.

Main Message:
The increasing popularity of e-cigarettes as a "safer" form of smoking has led to an increase in nicotine exposures, particularly in pediatric patients. The lack of regulation regarding packaging and labeling of e-cigarette liquid nicotine poses significant risks to children. It is essential for healthcare providers to be aware of the symptoms of nicotine poisoning and the clinical management of nicotine toxicity. Additionally, regulatory measures should be implemented to ensure the safety of e-cigarette liquid nicotine packaging and labeling to prevent accidental exposures.

Holliday, Richard, Philip M. Preshaw, Vicky Ryan, Falko F. Sniehotta, Suzanne McDonald, Linda Bauld, and Elaine McColl. “A Feasibility Study with Embedded Pilot Randomised Controlled Trial and Process Evaluation of Electronic Cigarettes for Smoking Cessation in Patients with Periodontitis.” Pilot and Feasibility Studies 5, no. 1 (December 2019): 74. https://doi.org/10.1186/s40814-019-0451-4.