particularly when the device has been modified ; severe burns may result . Ocular injuries and house fires have also been reported .
The nicotine liquid itself poses a particular risk as it can be quite concentrated . Toxicity occurs primarily through ingestion , but nicotine can also be absorbed through the skin . Common symptoms of nicotine toxicity include nausea , tachycardia , dizziness and tremor ; severe symptoms include dysrhythmia , cardiac ischemia , respiratory depression , seizures , coma and death . US Poison Control Centers receive numerous calls regarding nicotine ingestion every month , with the majority of these cases occurring in children under 5 years old .
Finally , the topic of lung injury came to the forefront in 2020 , as the CDC designated an outbreak of Electronic Cigarette or Vaping Product Use-Associated Lung Injury ( EVALI ). There were 2,807 hospitalizations and 68 confirmed deaths in that outbreak , which was ultimately linked to THC-containing vaping liquid with added vitamin E acetate . Other liquids can cause lung injury with inhalation , but they are not typically fatal .
ENDS contain various oncogenic compounds and clearly pose a risk for future lung cancers , as well as oral and head and neck cancers . Seeing these present in people who have never smoked traditional cigarettes will likely take decades . 1
SMOKING : SLOWLY TAKING YOUR BREATH AWAY RECOMMENDATIONS FOR PROVIDERS
Ask inclusive questions . The traditional “ Do you smoke ?” may not capture patients who use ENDS or other devices , who do not consider themselves to be smokers . Instead , consider “ In the past year , have you used a tobacco product such as cigarettes , e-cigarettes , cigars , chewing tobacco , etc .?”
Those who treat children and adolescents should be cognizant of the prevalence of ENDS use in teens , and consider including related counseling and education . Be sure to include nicotine poisoning on the differential for children who may live in homes where such products are present .
Encourage adult users of ENDS to wash their hands after handling vaping liquid . Adults should also keep their devices and liquid secured safely , out of reach of children . In general , do not recommend ENDS as a method of smoking cessation . Those looking for support for smoking cessation can find resources from the national quit line : 1-800-QUIT-NOW or www . smokefree . gov .
1 . Bracken-Clarke D , Kapoor D , Baird AM , Buchanan PJ , Gately K , Cuffe S , Finn SP . Vaping and lung cancer - A review of current data and recommendations . Lung Cancer . 2021 Mar ; 153:11-20 . doi : 10.1016 / j . lungcan . 2020.12.030 . Epub 2021 Jan 2 . PMID : 33429159 .
Dr . SarahBeth Hartlage is the Associate Medical Director for the Louisville Metro Department of Public Health and Wellness .
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