E-cigarettes an evidence update A report commissioned by Public Health England

E-cigarettes: an evidence update9. E-cigarettes, nicotine content anddeliveryBackgroundWe have undertaken a review of available evidence concerning nicotine released byEC. The review is divided into four parts, covering nicotine that EC use (vaping)releases into ambient air, nicotine content of e-liquid, nicotine content in e-vapour, andnicotine delivery to EC users (vapers). The main concern with nicotine in EC relates tothe question of whether EC use exposes users or bystanders to the risk of nicotinepoisoning. For this reason, we start with a short introductory review of this topic.Toxicity of nicotineNicotine in the form of tobacco and more recently NRT has been available to thousandsof millions of people and large numbers of them, including small children, have ingestedconsiderable doses of nicotine. Fatal nicotine poisoning, however, is extremely rare.This fact strongly contradicts the often-repeated claim that an ingestion of 30-60mg ofnicotine is fatal. The source of this claim proved difficult to locate – textbooks just citeolder textbooks. Eventually, the assertion was found to be based on dubious selfexperimentsconducted in the 1890s [69].We are aware of one unconfirmed newspaper report of a fatal poisoning of a two-yearold child [70] and of three published case studies of small children who drank e-liquid. Atwo-year old was admitted to hospital with vomiting, ataxia, and lethargy, and wasdischarged after 24 hours of observation [71]. In the second report, an 18-month old girldrank 24mg nicotine in e-liquid, vomited and was irritable, and recovered fully within anhour or so [72]. The third article presented a case of a 30-month old child suspected tohave ingested e-liquid. The quantity of e-liquid was uncertain and the child wasasymptomatic with all clinical observations reported to be normal [73].With the increase in EC use, there has been an increase in calls to poison centresfollowing accidental exposures but these remain lower than calls following suchexposure from tobacco and none resulted in any serious harm [74] (see next chapter forUK data). Serious nicotine poisoning seems normally prevented by the fact thatrelatively low doses of nicotine cause nausea and vomiting, which stops users fromfurther intake.Apart from accidental poisoning, nicotine has also been used in suicide attempts.Suicide attempts with large amounts of pesticides containing nicotine sulphate oftensucceed [75] but completed suicides using e-liquids are extremely rare. Where adults63