Liquid Nicotine Toxicity. Kim JW, Baum CR. Pediatr Emer Care 2015;31:517-524.
This review of liquid nicotine toxicity is part of the continuing medical education series in Pediatric Emergency Care.
While there are a few good clinical nuggets buried in this review, they are surrounded by so many distracting and unnecessary epidemiological facts that the whole paper — though relatively short — is a chore to read. In addition, some of the “facts” are wrong. For example::
A study found that the proportion of calls that poison control centers received regarding e-cigarettes and cigarette exposures increased from 0.3% in September 2010 to 41.7% in February 2014, 51% of which were in children 0 to 5 years of age.
Anyone editing this piece should have questioned immediately whether it was even remotely possible that 41.7% of all poison center calls involved exposure to cigarettes or e-cigarettes. A quick review of the 2014 MMWR report that is the basis for this claim reveals that, in fact, this is not the case:
Calls about exposures to e-cigarettes . . . now account for 41.7% of combined monthly e-cigarettes and cigarette exposure calls to PCs.
Quite a different statement.
In addition, some of the statements relating to clinical toxicology are in error, or at least questionable. The authors say that “The estimated lethal dose of nicotine is 1 mg/kg.” As I explained in my Emergency Medicine News column on e-cigarette toxicity, that oft-repeated “fact” is based on an anecdotal report going back a century-and-a-half, and has been recently challenged in a paper by Mayer in Archives of Toxicology. Most likely the fatal dose is much higher.