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

E-cigarettes: an evidence updatedrank up to 1,500mg of nicotine in e-liquid, the result was vomiting and recovery withina few hours [76]. One fatal outcome was recorded with 3,950mg of nicotine found ingastric content. The victim seems to have drunk three vials of e-liquid totalling over10,000mg of nicotine[76]. An intravenous injection of unknown quantity of e-liquid alsoresulted in death [77].E-liquid normally comes in 10ml bottles containing up to 360mg of nicotine (see below).This poses no risk to vapers if used as intended. The liquid however should be in‘childproof’ packaging to prevent small children, who may find the flavouring appealing,from drinking it. This seems to have been widely accepted by the EC industry. All e-liquids we have seen so far in the UK and globally were sold in child-resistantpackaging.Review methodsWe searched the US National Library of Medicine (Pubmed) using the following searchterms: ((cotinine OR nicotine) AND (blood OR plasma OR urine OR saliva OR liquid ORaerosol OR pharmacokinetic$)) AND (electronic cigarette$ OR e-cig$ OR ENDS). Thissearch returned 161 records. The abstracts of all records were screened.Papers were included if they were peer-reviewed and presented data regarding nicotinein e-liquid, aerosol, or body fluids (blood, saliva or urine). Studies that reported data onblood, salivary, or urine cotinine were also included.A total of 112 records were excluded as they did not contain any relevant information,leaving 49 records. The full papers of these records were retrieved and reviewed.From the full text review, 25 studies provided data regarding nicotine content of ambientair, e-liquid and vapour, and 16 provided data on nicotine delivery to users. Theremaining eight papers did not contain any relevant information. Three further relevantpapers were published during the writing of this report and were also included.Nicotine in ambient air, e-liquid and e-vapourWe identified five studies of nicotine in ambient air, 14 studies of nicotine in e-liquid andnine studies of nicotine vapour. The results are summarised below. We tabulate theresults where appropriate and provide a narrative summary where there are only a fewstudies available. Each section is concluded with a brief summary.Passive vaping: Nicotine from e-cigarette use in ambient airFour studies examined nicotine exposure from passive vaping. Long et al., 2014measured nicotine content of EC exhalations. EC exhalations contained eight times less64