Safety

The measure follows the nicotine-poisoning death of a toddler

https://www.consumeraffairs.com/e-cigarette-warnings-and-lawsuits

Liquid nicotine sold in New York must be packaged in childproof containers under terms of a new law signed by Gov. Andrew Cuomo yesterday. The measure also bans the sale of liquid nicotine to those under 21 in New York City and under 18 in the rest of the state.

New York banned the sale of electronic cigarettes to minors in 2010, but did not explicitly ban the sale of the liquid nicotine, according to a news release from the governor’s office.

“This action will help combat nicotine addiction by keeping it out of the hands of minors, as well as prevent a heartbreaking accident that can occur if a child is exposed to this potentially dangerous substance,” Cuomo said. “I am proud to sign this legislation into law and thank the sponsors for their work on this much-needed initiative.”

The measure follows the death of a one-year-old Fort Plain, N.Y., toddler who died after swallowing liquid nicotine.

Assemblywoman Linda B. Rosenthal (D-Manhattan), who sponsored the bill, cited the boy’s death as a reason why the law was needed.

“The accidental death of the one-year-old boy from Fort Plain, N.Y. as a result of liquid nicotine poisoning, the first of its kind in the nation, makes clear the need for this kind of common-sense legislation,” Rosenthal said in a statement.

Highly toxic

Liquid nicotine, often known as electronic liquid or e-liquid, is a composite of nicotine and other chemicals. Concentrated liquid nicotine is highly toxic, even in small doses, and if ingested, liquid nicotine may cause tremors, vomiting, seizures, and potentially, death. For infants and children, ingesting liquid nicotine is particularly lethal.

According to a 2014 Centers for Disease Control Report, the number of calls to poison control centers involving liquid nicotine rose from one per month in September 2010 to 215 per month in February 2014. More than half of the calls (51.1%) involved children under age 5.

http://abcnews.go.com/Health/childs-death-liquid-nicotine-reported-vaping-gains-popularity/story?id=27563788

A toddler from upstate New York could be the first child to die from liquid nicotine, the substance used in e-cigarettes, poisoning in the U.S., concerning health officials as e-cigarettes continue to rise in popularity.

Police reported that the 1-year-old child died after ingesting liquid nicotine at a home in Fort Plain, New York, on Tuesday. The child was found unresponsive and rushed to a hospital where he was later pronounced dead.

Fort Plain police released a statement saying the death is believed to be a “tragic accident.” They declined to say whether the liquid nicotine was associated with an e-cigarette.

But health officials are concerned if steps aren’t taken to protect children, they could see more fatal accidents similar to this one.

The rise of e-cigarettes and “vaping” in recent years has also meant a rise in the purchase of liquid nicotine. Coming in flavors like cotton candy or gummy bear, health officials say that the brightly colored liquid could appeal to young children.

“One teaspoon of liquid nicotine could be lethal to a child, and smaller amounts can cause severe illness, often requiring trips to the emergency department,” the American Association of Poison Control centers in a statement today. “Despite the dangers these products pose to children, there are currently no standards set in place that require child-proof packaging.”

In November the American Association of Poison Control Centers announced that the number of dangerous “exposures” to liquid nicotine has skyrocketed in recent years with 3,638 exposures as of Nov. 30. An exposure means coming into contact with liquid nicotine through ingestion, inhalation or by absorbing the substance through the skin.

The number is more than double the 1,543 exposures reported in 2013 and exponentially higher than in 2011 when 271 exposures were reported.

Before this week, the only confirmed death related to liquid nicotine happened in 2012 when a man injected himself with the substance, according to the American Association of Poison Control Centers.

Dr. Donna Seger, director of the poison control center at Vanderbilt University Medical Center, said her center has started to get more calls about exposure to e-cigarettes or liquid nicotine.

“They’re not that difficult to get into,” Seger said of the vials that contain the nicotine. “The issue is once the exposure occurs, it could be bad.”

Seger said just a small amount of nicotine can cause dangerous symptoms in children, including seizures.

Phil Daman, president of the Smoke-Free Alternatives Trade Association, said he was “saddened to hear the terrible news.”

“[We] want to always be mindful to put safe products on the market,” said Daman, who said the trade association recommends childproofing products to “err on the side of caution.”

Daman questioned if the child could have gotten a hold of a high-grade liquid nicotine that could be a much higher concentration than what is in many common e-cigarette products. Because e-cigarettes are not federally regulated there is a wide-range of liquid that could be purchased to use in e-cigarette products, ranging from potent high grade liquid nicotine to material that has an extremely small amount of nicotine.

In April the U.S. Centers of Disease Control and Prevention warned they were seeing an increase of calls to poison control centers for liquid nicotine exposure and children were becoming sick after ingesting, inhaling or absorbing the chemical through their skin. The most common symptoms were vomiting, nausea or eye irritation.

“Use of these products is skyrocketing and these poisonings will continue,” U.S. Centers for Disease Control and Prevention Director Dr. Tom Frieden said in April. “E-cigarette liquids as currently sold are a threat to small children because they are not required to be childproof, and they come in candy and fruit flavors that are appealing to children.”

To combat these cases of increased exposure some state lawmakers have introduced bills that would require e-cigarette companies to put child-resistant caps on bottles of liquid nicotine.

In New York State, a bill passed earlier in the year that would require child resistant containers for liquid nicotine. Gov. Andrew Cuomo is set to sign the bill in the next few weeks, according to ABC News affiliate WABC-TV.

At least one e-cigarette, Vapor World, changed their packaging this year so that bottles of liquid nicotine are more child resistant.

http://consumer.healthday.com/public-health-information-30/centers-for-disease-control-news-120/nicotine-poisoning-of-infant-highlights-e-cig-dangers-docs-report-687620.html

10-month-old boy was sickened but survived toxic ingestion of liquid used for ‘vaping’

Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And “More information” links may no longer work. Questions about personal health should always be referred to a physician or other health care professional.

WEDNESDAY, May 7, 2014 (HealthDay News) — The story of a 10-month-old boy rushed to a hospital after ingesting the refill liquid used in e-cigarettes spotlights an emerging safety issue, the doctors who treated him say.

The child recovered. But the consequences of children accidently consuming the nicotine in these refill vials can easily become tragic, Dr. Robert Bassett, of Einstein Medical Center in Philadelphia, and two colleagues report in the May 7 issue of the New England Journal of Medicine.

Just “one teaspoon of a 1.8 percent nicotine solution could be lethal” to a 200-pound person, the doctors pointed out.

The recent rise in such poisonings among children, tied to the surging popularity of e-cigarettes, highlights “the need to educate patients and parents about this danger and advocate for measures that will help prevent potentially fatal liquid nicotine poisoning of infants and young children,” the physicians said.

The Philadelphia case report is hardly an isolated one, experts note. In April, the U.S. Centers for Disease Control and Prevention warned that the number of calls to poison control centers for nicotine poisoning from e-cigarettes has risen dramatically in recent years. Calls related to poisoning from the liquid nicotine used in e-cigarettes ran at a rate of roughly one a month in 2010, but jumped to 215 in February of this year alone.

Even more troubling, more than half (51 percent) of the poison calls involved children aged 5 and younger, while 42 percent involved people aged 20 and older, the CDC said.

“We have not had an unintentional poisoning death from e-cigarettes yet in the United States that we know of, but the potential is there given the amount of concentrated nicotine in these solutions — it would not take a lot for a child death to occur,” Dr. Tim McAfee, director of the CDC’s Office on Smoking and Health, said at the time.

In the Philadelphia case, Bassett and his colleagues said the boy was taken to the hospital after ingesting a “small” amount of e-liquid nicotine bought at a commercial vaping (or “vape”) shop. The liquid contained 1.8 percent nicotine as well as “unknown concentrations” of other chemicals. After drinking the toxic liquid, the boy began vomiting, his heart rate sped up, and he exhibited loss of muscle control, the doctors reported.

The 10-month-old was lucky, however, because he never lost consciousness and his symptoms gradually subsided about six hours after first being admitted to the hospital.

But the physicians who treated him said the case raises troubling issues.

“The [U.S.] Food and Drug Administration does not currently regulate nontherapeutic nicotine; this raises concerns that in the ballooning unregulated liquid nicotine market there may be variability in nicotine dosing and introduction of unintended toxic ingredients,” they wrote.

There’s also a lack of consistent package labeling or child-protective packaging, the doctors noted. Many of the refill vials carry colorful labeling, “suggestions of edible ingredients [‘lemonade’],” and even “visually appealing cartoons” that might attract a child’s curiosity, Bassett’s team said.

Speaking at the time of the CDC’s warning, experts agreed that the danger to children from e-cigarette refills is real.

Dr. Vincenzo Maniaci, an emergency medicine specialist at Miami Children’s Hospital, said that “the concentration of nicotine in these solutions is significant and they need to be made childproof and regulated. Especially for kids under the age of 5, this amount of nicotine can be fatal.”

The CDC’s McAfee noted that the U.S. Food and Drug Administration is planning to propose regulations for e-cigarettes. He added that he hopes these regulations will include how the product is packaged, including childproof caps and warning labels.

“These things can be hardwired into these products, rather than being left to the whim of the manufacturer,” he said.

Poisoning from the liquid nicotine in e-cigarettes can happen in one of three ways: by swallowing it; inhaling it, or absorbing it through the skin or membranes in the mouth and lips or eyes, McAfee said. Once it is in a person’s system, nicotine can cause nausea, vomiting or seizures.

If those symptoms occur, the patient will typically be told to go straight to the emergency room, said Amy Hanoian-Fontana, from the Connecticut Poison Control Center.

If there are no symptoms, then the patient will be told to stay home and the center will call again in a few hours to see how the patient is doing. If liquid nicotine was spilled on the skin, the person should wash his or her skin in lukewarm water for about 20 minutes, Hanoian-Fontana added.

“We want to know what happened, when it happened and if the person is having any effects from the liquid nicotine,” she explained. “Then we are going to make a determination whether this is something we can keep at home, or if they are having severe symptoms we may recommend that they go into the emergency department. It’s very case-based, depending on the situation.”