National Poisons Information Service

A service commissioned by Public Health England

 

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Members of the public

seeking specific

information on poisons

should contact:

 

In England and Wales:

NHS 111 - dial 111

 

In Scotland:

NHS 24 - dial 111

 

In N Ireland:

Contact your local GP or

pharmacist during

normal hours; click here

(www.gpoutofhours

.hscni.net/) for GP

services Out-of-Hours.

 

In Republic of Ireland:

01 809 2166

 

Healthcare

professionals seeking

poisons information

should consult:

www.toxbase.org

Electronic cigarettes

The use of electronic nicotine delivery systems, including electronic cigarettes or e-cigarettes, has become commonplace within the UK and elsewhere. These delivery systems deliver a vapour which is then inhaled. This is generally achieved by the device heating liquid to produce a vapour containing various concentrations of nicotine, propylene glycol and flavourings, which is then inhaled.


The contents of e-cigarettes and their liquid refills vary but may contain substantial concentrations of nicotine, which could lead to highly toxic exposures if swallowed or used in other unintended ways. Refill solutions contain larger quantities of fluid than individual e-cigarettes, sometimes substantially larger. They are potentially a greater acute hazard due to the larger volume that may be ingested, either accidentally or intentionally.


The NPIS received 262 telephone enquiries concerning e-cigarettes and their refill solutions in 2018/19. This is similar to the number of enquiries received in each of the previous four years (min 225, max 272 enquiries per annum). Thirty-nine per cent of enquiries this year originated from hospitals (all departments). Children aged less than five years were involved in 40% of enquiries. The majority of exposures (184 of 262) were accidental; however, 56 (21%) concerned intentional exposures. The remainder of enquiries included adverse reactions to intended use, recreational misuse and ‘therapeutic errors’. Where the individual route of exposure was specified, ingestion was the most common (223), although multiple routes of exposure also occurred and in one case the liquid was injected. Twenty-seven exposures involved eye contact and eight of these occurred when the liquid was mistaken for eye drops. In another case liquid was mistakenly used as ear drops.


Where the clinical features were known at the time of the enquiry, 177 enquiries concerned patients who had no features of toxicity and 75 features of only minor toxicity. Four enquiries concerned patients with moderate toxicity. One patient had severe features. Features of toxicity included eye pain and conjunctivitis, irritation of the oral cavity, haemoptysis, nausea, vomiting, palpitations and dizziness.


It is of concern that so many of the exposures were accidental and occurred in young children and that nine enquiries occurred when e-cigarette products were mistaken for medicines: either eye or ear drops. In two cases these were administered to someone else by a parent or carer. Conversely, it is also of concern that the number of enquiries concerning deliberate exposure has increased, both in absolute numbers and as a percentage of enquiries. The nicotine liquid in e-cigarettes and their refills contains doses of nicotine that are toxic when swallowed. Even small volumes have the potential to cause serious harm to a small child when swallowed or used as eye drops or ear drops. These products need careful storage to lessen the chance of accidental exposure and consideration should be given to how the products are presented, to minimise the risk of them being confused with eye and ear drops.

 


Information from the NPIS Annual Report 2018/19.

 

| Reserach we undertake | Antidotes | Button batteries | Carbon monoxide | Cyanide | 2,4-dinitrophenol | Drugs of misuse | Electronic cigarettes | Glycols and methanol |Household products | Iron poisoning | Lead exposure | NSAIDs | Oral anticoagulants | Pesticides | Snake bite |