A Vaper's Guide to Avoiding Nicotine Poisoning
As a company owned and run by a number of mothers and fathers of young children, we take the protection of children extremely seriously. Protecting your young children from accidental exposure to nicotine is of utmost importance as liquid nicotine can and does kill when ingested in large enough quantities.
A 2014 study published by the Centers for Disease Control and Prevention (CDC) in Morbidity and Mortality Weekly Report showed a rapid increase in the number of calls to poison control centers that involved e-cigarettes over a four year period. That's not all that surprising given the rapid rise in the number of vapers in the United States during that same time period.
However, just over half of those calls were for children under the age of five showing that this is a vulnerable demographic that requires diligent protection. In total, the FDA reports that, between January 2012 and April 2017 there were 8,269 calls to Poison Control or other emergency services related to liquid nicotine exposure in children six years old or younger.
The CDC noted that toddlers and young children also frequently find and eat cigarettes, however, the ingestion of vape juice tends to lead to a higher rates of what the CDC refers to as "adverse health effects" after exposure. That's symptoms to you and me and the most commonly reported symptoms were vomiting, nausea and eye irritation.
Interestingly, 42% of the calls to poison control reported by the CDC involved individuals who were older than 20 years of age which shows that it is not just children who are at risk of nicotine poisoning. Adults can also suffer, whether through accidental ingestion, improper handling of nicotine containing liquids or through vaping excessive nicotine.
Another vulnerable population is pets. Your four legged, furry or feathered friends can also get into your vape juice stash. Nicotine is poisonous to animals, just as it is to humans. Be sure to keep your pets in mind as you read this article as many of the same things apply to preventing nicotine poisoning in pets.
How Does Nicotine Poisoning Occur?
According to the American Association of Poison Control Centers, there are three ways you can get nicotine poisoning from vape juice:
1. Drinking E-Juice
A child is much more likely to be attracted to a bottle of e-juice if it is brightly colored or looks similar to a kid friendly product. The FDA has cracked down on the irresponsible practice of producing e-liquid in packaging that looks like juice boxes, whipped cream, sugary kid's cereal or other ingestible items. In November of 2018, the FDA sent out warning letters to 17 vape juice manufacturers warning them to cease and desist packaging their products to resemble kid-friendly foods.
It's easy to see why the FDA was concerned. Some of the products were blatantly mimicking real food products that kids regularly consume in a way that absolutely would be confusing to a small child and thus was unnecessarily putting children at risk of nicotine poisoning.
Check out some of the examples the FDA found:
All 17 companies complied with the FDA warning letters and, hopefully, this will deter manufacturers from opting for these types of unfortunate packaging choices in future. Nonetheless, as a parent you should be alert to any products that mimic food and especially any that are colorful or appear kid-friendly. If you notice bright colors or unicorns on the bottle, your child definitely will, too.
The most recent permutation of this practice was the case of a couple of e-juice manufacturers who crafted their bottles to look exactly like prescription cough medication bottles! Keep any e-juice that looks even remotely like something you would eat or drink out of your house.
Even e-juice bottles that do not appeal to kids can wind up being a danger. Young children are naturally curious and may put all kinds of items in their mouths as they explore the world. Residual e-juice or drips on a bottle can be ingested in this manner.
2. Spilling E-Juice on the Skin
It's not necessary to drink vape juice directly in order to ingest nicotine. Nicotine can also be absorbed through the skin. This means that, if you or your baby get e-liquid on your skin, the nicotine will penetrate the dermal layer and make its way into your bloodstream. This ingestion pathway is less direct and obviously takes a bit longer than if you drink vape juice directly. Because of this, there's no need to panic should an accidental spill expose you or your baby's skin to e-liquid. However, it should be immediately and throughly washed with soap and water to prevent absorption.
A more direct ingestion pathway is getting e-juice in your eyes. Not only can this cause potentially severe irritation to the delicate mucous membranes of your eyes, it will also allow the nicotine to be more rapidly absorbed than if it had to penetrate your skin. Immediately flush your eyes with copious amounts of water.
Flushing with water is the best thing to do in this situation. We have a special eye wash station for just this purpose in our e-liquid laboratory. Fortunately, to date, due to the careful and meticulous work of our lab techs, it's never been used.
3. Inhaling Too Much Vapor
The first two methods of nicotine poisoning especially pertain to children and pets while the third primarily covers the vaper himself. If you vape too much, too frequently or use too high of a nicotine level, you increase your exposure to nicotine and thus the possibility of nicotine poisoning. Always vape the lowest nicotine level that you can comfortably remain at. Vaping a higher nic level will only increase your addiction level as well as the possibility of nicotine poisoning.
Also, keep in mind that there is not a simple, 1-to-1 comparison between vaping the same nicotine level juice in different electronic cigarette set ups. The power of the device you are using will dramatically affect how much nicotine actually gets from the e-juice into your lungs. Vaping a 12 mg vape juice in a small cig-alike or pod style device will not introduce nearly as much nicotine to your lungs as vaping that same e-juice in a device with a more powerful battery.
Battery strength is also not the only factor. The ohms rating of the coil you use will also affect nicotine consumption. Coils are generally rated by ohms which, in simple terms, measures the electrical resistance or how freely electricity travels. The lower the ohms rating, the more powerful the coil is and the more nicotine will be present in the vapor produced. A higher ohms rating, on the other hand, means a lower powered coil that will produce vapor that is less potent. You can find out more about the experiential difference between ohms ratings by reading our blog post on the subject.
All three of these factors affect the level of nicotine in the vapor you are inhaling but they don't all have the same level of influence. You can think of them as three different interlocking gears. The three gears all influence the nicotine level but they're not all the same size.
Understanding this, you can see that it is possible to vape lower nicotine e-juice but still get a powerful nicotine hit by using a more powerful battery and/or a lower ohm coil. If you have small children in the house, think about using this to your advantage by opting for a more powerful e-cig set up paired with a lower nicotine e-juice. You'll still get the same nicotine when you vape, but you'll reduce the danger to your child by only having less hazardous, lower nicotine e-liquid in your home. A good vape shop can help you select a hardware set up that will allow you to achieve this and you'll usually be able to try it out before you buy to make sure it works for you.
How Much Nicotine is Too Much?
According to the CDC, the lethal dose of nicotine is estimated "to be about 50 to 60 mg" for an adult weighing 150 pounds. However, this number has been hotly debated. Even WebMD mentions the controversy, noting that some research suggests the lethal dose may in fact be a lot higher.
And there are good reasons to question the CDC number. It was established many decades ago and has not been updated since. Yet, if 60 mg really was a lethal dose, that would make nicotine potentially more lethal than cyanide which, given tobacco's long history of widespread use, seems unlikely.
Animal studies also suggest a higher number is more probable. 60 mg is equal to 0.8 mg per kilogram of body weight. However, animal studies show that mice can tolerate up to 3.3 mg/kg of body weight and rats can go all the way up to 50 mg/kg.
In addition, over the decades doctors and scientists have seen a good number of unfortunate incidents involving nicotine overdose, either as the result of accidents or suicide attempts. These incidents suggest that the true lethal dose of nicotine is significantly higher than the number the CDC reports. For example, an individual reportedly survived a suicide attempt with a dose of 4 grams (4,000 milligrams) of nicotine as reported in a 1931 scientific paper.
It is interesting to note that in giving the 60 mg number, the CDC references a study that was strictly an animal study and does not actually cite any numbers for lethal dose in humans (Lazutka et al. 1969). This was noticed by scientist Bernd Mayer, among others, who looked into the origin of the 60 mg number in detail in his paper published in the Archives of Toxicology entitled, "How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century."
Bernd's paper is a fascinating read if you enjoy that sort of thing. When Bernd mentions "self-experiments in the 19th century," that is exactly what he means. A pair of intrepid Austrian pharmacologists voluntarily self-administered doses of nicotine to themselves to find out what would happen. They were soon experiencing a "burning sensation in the mouth," "scratchy throat," and "increased saliva excretion." It went down hill from there. The good doctors were overcome with belching, flatulence, vomiting and something called "rectal tenesmus." Yes, we had to look it up, too. According to Healthline.com, it means "cramping rectal pain" and the feeling of needing to go but not being able to. After enduring all the drooling, burping, farting, vomiting and rectal cramping, the doctors reported losing consciousness and suffering from seizures for two hours before spending the next three days exhausted and plagued by feelings of "bleakness." One is left with feelings of awe at what some will put themselves through in the name of science.
However, the problem was, according to Bernd's paper, the relatively small amounts of nicotine the doctors were dosing themselves with could not possibly have caused some of the symptoms they reported. Bernd in particular questioned the reports of "clonic seizures" and the loss of consciousness at a dose of between 1 and 4 mg (remember, the lethal dose is supposed to be 60 mg and even that is now believed to be drastically underestimated).
Were these early self-experimenters gilding the symptomatic lily perhaps or could they have accidentally ingested far more nicotine than they thought they had? Dr. Konstantinos Farsalinos, a research fellow at the Onassis Cardiac Surgery Center in Greece who has published more than 70 studies and articles in international peer-reviewed scientific journals on the topics of smoking, tobacco harm reduction, and e-cigarettes put it succinctly. The 60 mg lethal dose number "came from self experiments of Austrian pharmacologists, who described really peculiar and unrealistic symptoms after ingesting just 1-4 mg of nicotine."
Dr. Konstantinos Farsalinos, M.D.
Bernd's paper concludes that the lethal dose of nicotine needs "to be revised in light of overwhelming data indicating that more than 0.5 g of oral nicotine is required to kill an adult." A half a gram is 500 milligrams, far above the 60 mg the CDC is reporting--and hundreds of times the dose that supposedly set the 19th century pharmacologists awash in bodily functions.
Regardless of the true number, nicotine is poisonous in quantity and especially so to more vulnerable individuals such as babies and children who have a lower body weight and less developed physiology. It's good to have some idea what constitutes a lethal dose in an adult but, in practice, no amount of nicotine is safe for a small child.
What Are the Symptoms of Nicotine Poisoning?
According to the American Association of Poison Control Centers, the most common symptoms of nicotine poisoning are nausea, vomiting and dizziness. If you or your child is experiencing any of these symptoms, you'll want to contact Poison Control to get expert advice on what to do. We'll go over the three ways to get advice from Poison Control later in this post.
According to WebMD, other symptoms include:
These are early symptoms of nicotine poisoning and are most likely to come on within 15 minutes to an hour after exposure. If the symptoms progress, between 30 minutes and 4 hours after exposure you may experience:
In severe cases, nicotine poisoning can lead to seizures, coma, respiratory arrest and cardiac arrest leading to death.
What About Child Proof Packaging for Vape Juice?
The Child Nicotine Poison Prevention Act of 2015 gave the Consumer Products Safety Commission (CPSC) authority over the packaging of liquid nicotine containers. The bill was introduced on January 8th, 2015. It passed a Senate vote on December 10, 2015 and Congress also passed the bill a month later. On January 28, 2016, it was signed by the President of the United States and became law.
The bill requires that any liquid nicotine container that is sold, manufactured, distributed or imported into the United States must be "packaged in accordance with the standards provided in section 1700.15 of title 16, Code of Federal Regulations." Section 1700.15 is a Federal Code that sets out safety standards for most household products that are potentially dangerous to children.
Key aspects of the code include:
The key take away are the words, "child resistant." It is a common misconception that child resistant packaging is child proof. It is not. As the Federal Code states, it is only effectively child resistant in 80 to 85% of trials. That means that in 15 to 20% of cases, a child will be able to open a child resistant package. That may still meet the requirements of the Federal Code but, of course, that is not nearly enough to meet the requirements of mom and dad.
DO NOT rely on child resistant packaging as the only thing between your precious little one and nicotine-containing liquids. Keep all bottles as well as any e-cigs themselves far out of reach of children.
Nicotine Salts and Nicotine Poisoning
Nicotine salts require special consideration when it comes to nicotine poisoning. Nicotine salts are a relatively new phenomena, first introduced to the vaping marketing 2015 by the manufacturer JUUL. In simple terms, nicotine salts are just a slightly altered form of nicotine that, through the addition of an acid, have a lower pH making them closer to the pH of your body. This alteration enables much higher nicotine levels in the resulting vape juice than were previously possible. Without that change, nicotine above 24 mg per milliliter is far too harsh to vape but by changing the nicotine to a salt form, it becomes possible to vape at 50 mg/mL or even higher.
This change is advantageous to vapers to some degree. It enables people who have had trouble making the switch from cigarettes to get a faster hit of nicotine that is similar to that produced by a cigarette. Smokers who have struggled to make the switch to vaping have found more success with nicotine salts. Nicotine salts also enable smaller, more portable devices which in turn use e-juice more sparingly which can be a money saver to frequent vapers.
However, the obvious disadvantage of nicotine salts is the increased danger of nicotine poisoning. Vaping such high nic levels puts the vaper in greater danger of overdosing and spilling 50 mg/mL on the skin or ingesting it is far more dangerous.
For these reasons, exercise greater caution with nic salt e-liquid, keeping it far out of reach of children and taking care to prevent spills or splashes. You should also closely monitor any symptoms you may feel when vaping as it becomes far more possible to vape too much nicotine when using such high nic levels. Do not use nicotine salts in a sub ohm device as the combination of high nic levels and a device that powerful will produce a vape cloud that is potentially dangerously high in nicotine levels. Nic salts are designed to be used in smaller pod type or other low power devices where the nicotine level makes up for the lack of oomph from the battery's more diminutive size.
Better still, consider opting not to use nic salts if you have a little one in the house. As discussed above, you can still get plenty of nicotine by using a higher powered e-cig device such as a sub ohm hardware set up (sub ohms means an ohms rating that is below 1, for example 0.2 ohms). These set ups are generally larger than pod style e-cigs, have more powerful and longer lasting batteries and use sub ohm coils that produce more vapor, flavor and throat hit. Many sub ohm vapers use 3 mg/mL vape juice and have no problem getting the nicotine they need. The power of the e-cig device amps up the effect of the much lower nic level in the juice itself.
Action Items: Preventing Nicotine Poisoning
What To Do If You Suspect Nicotine Poisoning
If you have any concerns that you or your child might have been exposed to toxic levels of nicotine or if you observe any of the symptoms of nicotine poisoning, immediately get in touch with Poison Control. There's no reason to guess what to do or to hesitate if you have any concerns at all. Poison Control offers expert help immediately and confidentially. You can ask questions, get advice and find out if you need to take additional steps.
In the United States, there are two ways to contact Poison Control. You can do so by using their web portal or by calling a toll free number.
The web portal will ask you questions in order to give you a recommendation specific to your circumstances. This is a good way to get advice if your situation is not an emergency but you have some concerns.
You can also call (800) 222-1222 to speak to a person. Your call will be routed based on your area code to the closest poison center that is designated to serve your area. Add this number to your phone contact list now so you always have it readily available.
If you want to be prepared in advance, download the Poison Control app. It is available in the iTunes Store or via Google Play. The app contains the same questions you would answer if you went through the web portal but they are available on your mobile device and can be accessed even if you are out of cell range or do not have access to the internet.
If you or your child is experiencing a medical emergency, DO NOT call Poison Control. Instead call 911 to get immediate medical attention. Poison Control is there to give you expert advice but in an emergency, that is not what you need, you need immediate medical help. A medical emergency in the case of poisoning is defined as:
If any of these symptoms are present, call 911.
How Kai's Virgin Vapor Protects Our Customers and Their Families
At Kai's Virgin Vapor, we have taken a number of steps to reduce the likelihood of our product being accidentally ingested by children: