More people, especially kids, are getting sick by spilling or accidentally ingesting the liquid nicotine that electronic cigarettes heat into a vapor.
As illness reports from electronic cigarettes mount, U.S. poison centers warn parents to store the liquid nicotine used in these battery-operated devices away from children.
The warning, issued Tuesday by the American Association of Poison Control Centers, comes as the group reports a surge in calls about exposure to e-cigarettes and the liquid nicotine they contain — from 269 nationwide in 2011 to 459 in 2012, 1,414 in 2013 and 651 this year, through March 24.
Slightly more than half of the reported exposures occurred in children under the age of 6, some of whom became very ill and required emergency room visits. Nausea and vomiting were the most significant symptoms.
E-cigarettes, which are booming in popularity but unregulated by the U.S. government, heat a liquid into a vapor that's inhaled. The liquid contains addictive nicotine — extracted from tobacco — as well as chemicals and flavorings such as chocolate and bubble gum.
Users, who say they "vape" rather than "smoke," can buy this liquid in gallon-sized containers to refill their devices, many of which resemble conventional cigarettes. The liquid can cause vomiting and seizures when ingested or absorbed through the skin. A single teaspoon in highly concentrated form can kill a small child.
"These concentrated products are significantly toxic in very small doses," Ashley Webb, director of the Kentucky Regional Poison Center, said in a statement. "When it comes to concentrated liquid nicotine, the danger is not just ingestion but with simple contact with the skin."
Adults should protect their skin when handling the liquid nicotine and keep it, along with e-cigarettes, locked up and out of reach of children, according to the AAPCC, which represents 55 centers. Also, they should properly dispose of it, so kids and pets aren't exposed to the residue or liquid left in the container.
Lee Cantrell, a toxicologist who directs the San Diego division of the California Poison Control System, found a 10-fold increase in reported pediatric exposures statewide from January 2013 through February 2014. He said some problems stemmed from people mishandling small cartridges of the liquid nicotine, including one person who mistook it for a pill and swallowed it and another who mistook it for eye drops.
He says other adults, when handling large replacement containers, have spilled the solution on their hands and developed nausea, began vomiting or felt their heart rate increase. He says the impact on kids can be more severe, adding, "Children should never be near these products."
Adolescents who used e-cigarettes were more likely to smoke conventional cigarettes, according to a study of nearly 40,000 youth published this month in JAMA Pediatrics. The study from the University of California-San Francisco found that e-cigarette use among middle and high school students doubled from 2011 to 2012, from 3.1% to 6.5%.
"E-cigarettes are likely to be gateway devices for nicotine addiction among youth, opening up a whole new market for tobacco," says lead author Lauren Dutra, a postdoctoral fellow at the UCSF's Center for Tobacco Control Research and Education.