Ver el código de «Electronic cigarettes»

==Background==
*Nicotine containing products that are currently not regulated by the FDA
*On 4/25/14, the FDA proposed legislation to allow them to regulate e-cigarettes like other tobacco products<ref>Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act [https://s3.amazonaws.com/public-inspection.federalregister.gov/2014-09491.pdf PDF]</ref>
*Nicotine usually suspended in a propylene glycol or vegetable glycerin solution (labeled as %PG/%VG)<ref>PG e-liquid, VG e-liquid or PG/VG Mix e-liqud? http://www.bestecig.com/help.asp?id=57</ref><ref>Carmines EL, Gaworski CL. Toxicological evaluation of glycerin as a cigarette ingredient. Food Chem Toxicol. 2005 Oct;43(10):1521-39</ref>
*From Sept 2010 - Feb 2014, there were 16,248 toxic exposures to traditional cigarettes and 2,405 toxic exposures to e-cigarettes<ref>CDC reports. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6313a4.htm</ref>
*Exposures to e-cigarettes increased from 1/month to 215/month over that time period
===Product Types===
*Some are fixed products with no refill capabilities (Ex. Blu e-cigarettes) while others can be refilled with replacement nicotine fluid
*Common strengths include 6mg/ml (low), 12mg/ml (medium-low), 18mg/ml (medium), 24mg/ml (high) and 36mg/ml (Ultra-high)
*Common refill sizes range from 5ml to 30ml
*Products come in a variety of flavors that can be enticing to children
*Bubble gum, root beer, extreme soda, Ecto-cooler, Banana cream pie, toasted marshmallow, etc.  

==Pathophysiology==
*Fatal intoxications are rare and estimates suggest 60mg - 500mg as a lethal dose.  Traditional cigarettes deliver approximately 2mg of nicotine <ref>Mayer B. How much nicotine kills a human? Tracing back the generally accepted lethal dose to dubious self-experiments in the nineteenth century. Arch Toxicol. 2014; 88: 5–7</ref>
===Absorption===
*Absorbed transdermally, orally and via inhalation
===Biphasic presentation===
*Initially excitation secondary to excitation of the presynaptic nAChR which facilitates release of neurotransmitters
*Second phase characterized by desensitization of the receptors and decreased neurotransmitter release

==Clinical Features==
{{Nicotine Clinical Features}}

==Evaluation==
*Exposure to nicotine containing liquid
*Toxidrome similar to nicotinism

==Work-Up==
*CBC
*Chem 7
*[[Urine toxicology screen]]

==Differential Diagnosis==
{{Nicotine Toxicity Differential}}

==Management==
{{Cholinergic Toxicity Treatment}}

==Disposition==
*Admit for symptomatic poisonings

==See Also==
[[Nicotine Poisoning]]

==References==
 
<references/>
[[Category:Toxicology]]