E-cigarettes and liquid nicotine have become very popular over the past few years. However, there is concern on the safety of these products.

AAPCC & GPC: E-Cigarettes and Liquid Nicotine Data

These numbers reflect the closed human exposures to e-cigarettes and liquid nicotine reported to poison centers as of March 31, 2020. The numbers may change as cases are closed and additional information is received. For more information on AAPCC data, please click here.

What are e-cigarettes?

• Electronic cigarettes (e-cigarettes) work by heating a liquid to produce an aerosol for users to inhale, a process called vaping.
• Also known as e-cigs, cig-a-likes, c-cigars, e-hookah, hookah sticks, personal vaporizers, mechanical mods, vape pens, electronic nicotine delivery system (ENDS)
• E-cigarette liquid consists of a base liquid, flavoring, and often nicotine or THC, active ingredient in marijuana.
• The concentration of liquid nicotine in e-cigarettes is usually higher than traditional combustible cigarettes.
• The liquid is available in different strengths and flavors.

Dangers of e-cigarettes

The lung injury known as EVALI (e-cigarette, or vaping, produce-use associated lung injury) was recognized in the summer of 2019, with cases peaking in September 2019 and steadily declining since then. It can present as progressive lung illness that can result in severe lung injury, hospitalization, and death.  Most, but not all, cases have been associated with people using informally sourced THC vape products, such as those bought on the street. Vitamin E acetate, a product used in many foods and cosmetics, has been linked with EVALI and has been found in many street-obtained THC products. Vitamin E acetate is typically safe for ingestion and application on the skin, but research suggests that when it is inhaled it can disrupt normal lung function. While vitamin E acetate seems to be a causative chemical, there is not enough evidence to say it is the only chemical in e-cigarettes that causes EVALI. Most of the flavorings and other ingredients in e-cigarette liquid have not been studied when inhaled and many of the risks with vaping are still unknown.

The aerosol that users breathe and exhale can contain harmful  and potentially harmful substances, including:

• Nicotine
• Ultra-fine particles that can be inhaled deep into the lungs
• Flavoring like diacetyl (a chemical linked to lung disease)
• Volatile organic compounds
• Cancer causing chemicals
• Heavy metals like nickel, tin and lead
• There is no way to know what each e-cigarette product contains.

Common mild symptoms to watch for:

• Nausea
• Vomiting
• Dizziness
• Drowsiness
• Fast or racing heartbeat
• High blood pressure

Common severe symptoms to watch for:

• Seizures
• Slow heartbeat
• Low blood pressure

Recommendations from the CDC:

• Don’t use THC-containing e-cigarette products, especially products obtained from informal sources.
• Don’t add vitamin E acetate, or any other ingredients, to commercially purchased e-cigarette products.
• E-cigarettes should not be used by youths, young adults, pregnant women, or those who don’t already use tobacco products.
• Those using e-cigarettes should not switch back to regular cigarettes, and should seek help from their primary care provider for other options to quit nicotine use.

Tips to prevent potentially harmful exposures to e-cigarettes or liquid nicotine:

• Always store e-cigarettes and liquid nicotine up, away and out of sight, preferably in a locked cabinet
• Make sure the cap on e-liquids is on properly after each use
• Wash your hands with soap and water after handling the products
• Clean up any spills immediately
• Keep e-liquids and liquid nicotine in their original container
• Follow specific disposal instructions on the label
• Call the poison helpline if you think someone has been exposed in a dangerous way to an e-cigarette or liquid nicotine.

Additional Resources

• FDA: Vaporizers, E-Cigarettes, and other Electronic Nicotine Delivery Systems (ENDS)
• CDC: Electronic Cigarettes
• AAPCC: Tobacco and Liquid Nicotine
• Think Before You Vape Handout