The Risk of Nicotine Poisoning

Before we discuss nicotine poising, this is the number to call to talk to your local poison control center if someone has ingested cigarettes, butts, chewing tobacco, or e-liquid: 1-800-222-1222. Your next best resource is poisonhelp.org.


Nicotine is toxic in large doses – doses far more than you would ever run into while smoking or vaping. Most nicotine poisoning historically has been due to using liquid nicotine as an insecticide, and harvesting tobacco crops by hand can also lead to nicotine poising as it is absorbed through the skin (which is how nicotine patches work). This is known as Green Tobacco Sickness.

nicotine molecule

Once in a while you’ll hear about a child getting sick from chewing on cigarettes, chewing tobacco, or cigarette butts, and one of the unintended and unwanted consequences of vaping is that sometimes the e-juice isn’t kept safely out of reach of children. If the bottle doesn’t have a childproof cap, they may drink the e-liquid, and if it contains nicotine – which most e-juice does – it means a call to EMS or a trip to the emergency room.

If at all possible, lock up your vaping gear and e-juice to protect any children in the home – and pets as well, as it takes very little nicotine to poison a cat or small dog.

It is very unlikely that you will be dealing with a lethal dose of nicotine, but especially for children, even a little nicotine can make them very ill. As little as 6 mg of nicotine can be a lethal dose for a child. They don’t have to drink it; nicotine is absorbed through the skin, so spilling too much e-fluid on themselves could make them sick. Even adults have died from ingesting nicotine, although it takes a very large dose to do that.

Reality Check

The human body does a pretty good job of processing low levels of nicotine, as found in vaping and smoking tobacco. In general, your body will metabolize half of the nicotine in about two hours, so within 4 hours most of it should be out of your system.

It’s estimated that the toxic dose of nicotine for an adult is about 500 mg. This is based on measuring the level of nicotine found in the blood of those who have died from nicotine poisoning.

A study by Dr. Konstantinos Farsalinos worked to determine just how much nicotine actually gets into a vaper’s blood stream. Using 18 mg/ml e-liquid, he had participants take 10 puffs over the course of 5 minutes and then as much as they chose to for the next hour. At 5 minutes and every 15 minutes after that, the researchers drew blood to measure the nicotine level.

Those who stopped after 5 minutes averaged 8 nanograms (ng) of nicotine per ml of blood. The heaviest vaper measured 48.1 ng/ml at 65 minutes, and 24.1 ng/ml was typical for those who vaped during the hour.

By way of comparison, the lowest nicotine plasma level recorded in someone who died from nicotine poisoning was 4,000 ng/ml – 500 times the level of those who quit after 5 minutes and over 80 times the level of the heaviest vaper.

In other words, it is extremely unlikely that anyone will get nicotine poisoning from vaping with even the highest nicotine e-juice. However, you can vape enough to get sick, so please don’t overdo it.

It also turns out that while nicotine can be absorbed transdermally, the real world danger is relatively minor. Looking at the nicotine level in e-juice and the absorption rate, you would have to choose not to wash it off for quite a while – hours perhaps – before it would begin to poison you. That said, kids and pets weigh less, so it takes a much lower dose to impact them. If it happens, wash immediately with soap and water and watch out for symptoms.

The great risk comes when nicotine is ingested. That’s where the danger is.

Play It Safe, Not Sorry

Over the Sept. 1, 2010 to Dec. 31, 2014 period, there were over 21,000 cigarette-related calls to US poison control centers. Over the same time period, they fielded just under 6,000 e-cig related calls. That number is way too high, and vapers need to be much more careful about storing their e-juice out of reach of children.

In January 2018, 450 cases of exposure to nicotine, whether by ingestion or through the skin, were handled by local poison control centers.

On the positive side, poison control centers dealt with fewer cases of nicotine exposure in 2016 and 2017 than they did in 2014 and 2015, the years with the highest number of reported incidents. This indicates that vapers and smokers are being more careful with the e-juice and cigarettes. Keep up the good work – we still have plenty of room for improvement.

Also, keep in mind that nicotine from a liquid will be absorbed into someone’s system more quickly than nicotine in tobacco. If you suspect someone has consumed e-juice, don’t waste any time.

Treatment

If they vomit, that’s a good thing. In 80% of cigarette-related cases, that’s what happens, and it gets most of the chewed up tobacco out of the stomach. With e-liquid, vomiting is only half as likely, and because the nicotine is in liquid form, some if it has been absorbed before vomiting can occur.

Normal emergency treatment for nicotine poisoning is to administer activated charcoal, which is as nasty as it sounds. It works to absorb the nicotine in the stomach and intestine, but again, liquid nicotine is absorbed much faster than nicotine in tobacco. Activated charcoal can help remove nicotine from the system, but that may be a slower process with liquid nicotine that has already been absorbed.

Emergency technicians will work to control seizures, provide intravenous fluids, and keep an eye out for respiratory failure. None of the usual techniques for removing impurities from blood are effective for nicotine, so it is especially important that it be kept away from children. Even with vomiting, activated charcoal, and IV fluids, it’s going to take time.

The prognosis is usually good, as few ingest enough nicotine for long-term damage, but that doesn’t make it any less stressful when a loved one has nicotine poisoning. And with a larger dose, the odds of long-term problems becomes a reality.

Symptoms of Nicotine Poisoning

Perhaps the most evident sign of nicotine poisoning is nausea and vomiting, which is part of the reason most people don’t ingest a fatal dose. Your body does what it can to purge this toxin, and it’s about 80% likely that vomiting will occur when cigarettes have been ingested, 40% likely after ingesting e-juice (per US poison control centers).

More than half of reported exposure to liquid nicotine was reported in children under 6 years old. Don’t let it happen with your e-cig or e-liquid.

Resources

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