Doctors Flag Risk of E-Cig Refills for Toddlers

Doctors issued a fresh warning Monday that toddlers were at risk from e-cigarette nicotine refills, saying even a few drops could make a child very sick.

In a letter to the journal Archives of Disease in Childhood, physicians in Birmingham, central England, reported the case of a 30-month-old girl who had to be rushed to hospital after putting a refill cartridge to her mouth and starting to vomit.

She was discharged six hours later, with no further symptoms.

It was not clear how much, if any, of the liquid the girl had ingested before her mother intervened.

But the case was the latest to underline "the risk posed by nicotine liquid to children", said the experts, who called for "public education and legislation to improve the safety profile of e-liquid containers."

Nicotine refills are available in strengths ranging from six milligrams per liter, a concentration of 0.6 percent, to 36 mg/l, or 3.6 percent.

In April, the U.S. Centers for Disease Control and Prevention (CDC) reported a surge in calls to poison centers after people accidentally swallowed or inhaled nicotine from a refill cartridge, or spilled it on their skin or in their eyes.

There was just one call in September 2010, and 214 in February 2014 -- half of them involving children under the age of five.

The CDC said there was no legal requirement for the liquids to be packaged in child-proof containers, and they came in sweet and fruit flavors "that are appealing to children."

Symptoms of nicotine poisoning range from burning in the mouth and throat to nausea, a racing heart, vomiting and weakness. Severe cases have included cardiac arrest and coma.

The new letter, signed by paediatricians at Birmingham's Good Hope Hospital, said just "one to two drops" at the 3.6-percent concentration could make a toddler seriously sick.

In an adult, they wrote, a dose as small as 40 mg could be lethal, and in children it is likely to be several times lower.

E-cigarettes typically work by vaporizing a liquid called propylene glycol, to which nicotine and flavoring have been added. Vapor is inhaled instead of smoke.

Critics say the gadgets have been a huge hit with young people, who form part of a snowballing market worth about $3 billion (2.3 billion euros) annually, with more than 400 flavors.