Accidental exposure to nicotine in e-cigarette refills has fueled a dramatic jump in calls to poison control centers, according to federal health authorities, who say the substance triggered eye, skin and inhalation injuries.
Kids drank flavored e-liquids, lured by deceptively sweet odors. Adults got squirts of nicotine in their eyes and through the skin. Nicotine poisons people when appreciable amounts of the substance are absorbed, inhaled or swallowed.
Calls to poison centers have largely involved e-cigarette vials used to refill the devices. Phone calls to poison centers rose from one per month in September 2010 to 215 monthly by February of this year, researchers at the Centers for Disease Control and Prevention reported Thursday in its Morbidity and Mortality Weekly Report.
More than half the calls to poison centers were about children exposed to toxic levels of nicotine, but 42 percent involved people 20 and older, also suffering from nicotine exposure.
By comparison, monthly calls involving conventional cigarettes didn't show a similar increase during the same time period. Hazards linked to cigarettes ranged from 301 to 512 calls per month and were more frequent in summer, researchers found.
"When e-cigarettes first came out, the nicotine was contained in a cartridge," said Dan Jacobsen of the North Shore-LIJ Center for Tobacco Control in Great Neck.
"Now, to make them cheaper and easier to use, they are refillable and because these refills have flavors, they entice children," he said. Flavors include chocolate, strawberry and bubble gum.
Jacobsen said it's time the U.S. Food and Drug Administration considered regulating the products, which have evolved from disposable devices resembling cigarettes to trendy wands from which billowing clouds of vapor are emitted.
He said there are no quality-control guidelines on their manufacture in the U.S. or abroad.
Dr. Tim McAfee, director of the CDC's Office on Smoking and Health, said the new report is designed as a wake-up call to the public and health care professionals.
"People are reporting symptoms through inhalation, eye exposure and skin exposure," McAfee said. "E-cigarettes have a reservoir of liquid that has a heavy concentration of nicotine."
The devices are battery-powered and also contain an atomizer with propylene glycol that can produce a vapor.
Among 9,839 poison control calls with information about severity of injuries, those from e-cigarettes were more likely to report adverse health effects.
Nicotine, a highly addictive substance that targets the brain, can cause serious cardiovascular side effects, such as dramatic palpitations and racing heart rate. The devices, however, are marketed as safe.
Dr. Shahriyour Andaz, director of thoracic oncology at South Nassau Communities Hospital in Oceanside, said although his work largely involves patients who've developed lung cancer caused by conventional cigarettes, the culprit in their addiction, he added, was also nicotine.
"There is 1 milligram of nicotine in a conventional cigarette, but an e-cigarette can have amounts several times as high," he said.
In high concentrations, nicotine can be deadly, say experts who warned Thursday that guidelines need to be set on the amount in e-cigarettes, which are highlighted as smoking-cessation devices. Nicotine patches and gum are regulated by the FDA.
The nicotine amount varies with the e-cigarette maker. The lowest concentrations are about 1.5 percent per volume But some sell e-liquids online with higher concentrations.
Brandon Rockstad, manager of Vapor World in Midwest City, Okla., sells e-liquids and nicotine. He said the amount of nicotine in his products varies, depending on the purchaser.
Vapor World can sell a gallon or more of e-liquids to brick and mortar stores, Rockstad said. "For personal use we do not sell products with a high nicotine concentration," he said.
The leader of an e-cigarette trade organization -- Smoke Free Alternatives Trade Association -- said in a statement she supports child-safety measures.
"We are aware of reports of increased calls to poison control centers that involve e-liquid and support federal age restrictions on the purchase of vapor products, childproof caps and proper labeling to safeguard against accidental ingestion," said Cynthia Cabrera, executive director.
Dave Dobbins, chief operating officer of the Legacy Foundation in Washington, an anti-smoking research group, said unless the FDA enacts guidelines -- as it said it will do -- e-cigarette poisonings will only increase.
"When you buy these products you don't even know how much nicotine is in them . . . it's the wild, wild West out there," he said.
Clearette, one of the nation's largest e-cigarette retailers, which has headquarters in Great River, did not answer calls Thursday. However, regional sales manager Michele Spierto told Newsday last year that e-cigarette sales are increasing worldwide, and that locally, sales are most vigorous on the South Shore.