Misuse of ‘e-juice’ for electronic cigarettes can be deadly

Michael Wooderson used to sell bubble gum-flavored nicotine “e-juice” at Aqueous Vapor, his Kansas City store where people can buy the increasingly popular refillable electronic cigarettes.

No longer. The danger was just too great that a small child would drink the flavored juice marketed in tiny plastic or glass refill bottles. One sip — nicotine is a potent neurotoxin — can kill a child.

“We don’t want to sell any flavor that might appeal to kids,” said Wooderson, a partner in a company that has six e-cigarette stores in Kansas and Missouri. “We’ve done away with several flavors that we used to carry.”

No federal health regulation yet limits e-liquid ingredients, which along with nicotine also contain other chemicals. Proposals governing e-cigarettes, possibly touching on e-liquid ingredients, are expected soon from the Food and Drug Administration.

It’s also possible that adults can overdose on nicotine because unlike a real cigarette, e-cigs don’t burn down. A nicotine overdose can induce vomiting and seizures, and lead to cardiac arrest.

Meanwhile, sellers like Wooderson are self-regulating after serious health consequences reported nationwide when children consumed dangerous amounts of e-liquids.

Many U.S. retailers also are worried about other e-liquid ingredients, including propylene glycol, polyethylene glycol and vegetable glycerin.

“We’re well aware of the risks,” said Jennifer Lowry, chief toxicologist at Children’s Mercy Hospital in Kansas City.

Lowry said Children’s Mercy did not think it had seen an e-liquid overdose in a patient, but “when e-cigarettes are just lying around a house, a child is going to get into it” and the possibility of ingesting something harmful grows, “especially if the liquid smells good, like vanilla.”

Toxicologists say e-liquids pose a more immediate danger to a child than tobacco because the liquid is absorbed more quickly, even in diluted concentrations. Adults also can be quickly harmed by absorbing spilled e-liquid through the skin.

Industry experts recommend that e-liquid users find out what ingredients are being used. But that may not be easy information to obtain, particularly if making online purchases. Some e-liquid manufacturers, including those overseas and “backroom” mixers, don’t list ingredients or percentages in the oils that make up the e-juice.

“Consumers need to ask the store for documentation about where they get their oils and the ingredient concentrations,” Wooderson advised. “And look for child-proof caps on the refillable bottles.”

Lowry said instances of e-liquid poisoning may be under-reported to date, possibly because the public isn’t yet aware of what caused a health reaction.

Doctors also are worried that adolescents are gravitating to e-cigarettes as a “safer” alternative to tobacco cigarettes, but “in reality the nicotine is just as addictive,” Lowry said.

In fact, Wooderson has observed that some adult customers, unaware of the true nicotine content in their e-liquid, tend to inhale even more puffs than they would with a tobacco cigarette.

“With a regular cigarette, you know when you’re done,” he said. “A lot of customers don’t know when to stop with an e-cig. Generally, if you take 10 puffs, you should stop, or you’ll get more nicotine than a tobacco cigarette.”

Experts say the nicotine content in e-juice generally ranges between a concentration of 1.8 percent and 2.4 percent, enough to cause illness in children. But higher concentrations — up to 10 percent — can be bought online.

A lethal dose at such levels would take “less than a tablespoon,” Lee Cantrell, a professor of pharmacy at the University of California, San Francisco, told The New York Times. “Not just a kid. One tablespoon could kill an adult.”

This story was originally published March 24, 2014 at 10:25 PM with the headline "Misuse of ‘e-juice’ for electronic cigarettes can be deadly."