• Cause: chewing an electronic cigarette device or ingestion of a refill liquid found in bottles and vials.
• Signs: most animals remain well. Common signs in symptomatic animals are vomiting, hypersalivation, agitation, and tachycardia following mild or low-dose exposures.
• Diagnosis: most commonly based on history of exposure.
• Treatment: oral fluids and supportive care, if required.
• Prognosis: typically very good following mild, low-dose exposures.

ℹ️Print off the owner factsheet E-cigarettes and pets to give to your client

• Most animals remain well but may develop salivation, agitation and vomiting following mild low-dose exposures.

• Symptomatic animals may have salivation, vomiting, agitation, and tachycardia.

• Use of electronic cigarettes is widespread.

• In the uncommon cases where severe signs occur (due to high exposures and/or small body weight patients), pets may require aggressive treatment.

• Antacids should be avoided in pets that have ingested nicotine as increasing the gastric pH will increase nicotine absorption from the stomach.

• An electronic cigarette is a device that simulates tobacco smoking, comprising an atomizer, a power source (usually a rechargeable battery), and a container such as a cartridge or tank filled with liquid. There is no smoke, but the user inhales a vapor.
• E-liquid is a solution of propylene glycol, vegetable glycerine and/or polyethylene glycol 400 (PEG400) and is available in various strengths of nicotine and thousands of flavors.
• The concentration of nicotine is usually 3-36 mg/ml. Note the highest strength legally available in the UK and Europe is 20 mg/ml (2%).
• Newer nicotine salt (nic salt) solutions are less harsh and less bitter and as a consequence e-liquids that contain nicotine salts are more tolerable to the user even with high nicotine concentrations.
• Various generations of electronic cigarettes have been available including cigarette lookalikes, vape pens, box mods and disposable vape pens.
• Vape devices are also used to smoke cannabis/tetrahydrocannabinol (THC), synthetic cannabinoids or cannabidiol (CBD) Cannabis poisoning.
• Vape devices use lithium-ion cylindrical batteries, which may also be chewed or swallowed Battery toxicity.
• The e-cigarette casing can result in oral injury when chewed and could potentially lead to gastrointestinal upset with a potential risk of foreign body obstruction if swallowed.
• Death in adult humans has occurred after IV injection of electronic cigarette solution and ingestion of a concentrated solution.

• Nicotine is an alkaloid from the tobacco plant (Nicotiana species) Plant poisoning: nicotine-like toxins.
• Nicotine causes cholinergic effects, with brief central nervous system (CNS) stimulation followed by CNS depression.
• Nicotine initially stimulates the autonomic nervous system causing brief excitation of the adrenal medulla, CNS, cardiovascular (due to the release of catecholamines), gastrointestinal systems (parasympathetic stimulation), salivary and bronchial glands and the medullary vomiting center. This is followed by blockade of the autonomic nervous system, inhibition of catecholamine release from the adrenal medulla and CNS depression.
• The oral bioavailability of nicotine is low as it is subject to first pass metabolism which converts it to inactive metabolites. In addition, nicotine is a weak base so absorption in the stomach is low because of the low pH. The oral mucosa is the main site of nicotine absorption, and it is also readily absorbed from the nasal mucosa. In addition, the emetic effect of nicotine also reduces absorption.
• The half-life of nicotine is short (2-2.2 hours in humans). The half-life in cats and dogs is unknown. Urinary elimination depends on the urine pH; excretion decreases as the urine becomes more alkaline.
• The oral LD50 of nicotine in dogs is 9.2 mg/kg but in this study the nicotine was given as drops in the mouth between the lips and gums and death occurred within a few minutes. Clinical signs have been reported when exposures exceed 1 mg nicotine/kg BW.
• Nicotine poisoning in animals is not common. Electronic cigarettes generally cause only mild effects due to low-dose exposures, poor absorption of nicotine in the stomach, and initial vomiting serves as self decontamination.

• Onset of nicotine toxicosis is generally rapid (within 15-30 minutes), but sometimes delayed up to 4 hours.
• Recovery can occur within a few hours, sometimes up to 24 hours in severe high-dose exposures.
• In the animals that develop severe signs (very uncommon) onset is usually rapid, within minutes.

Refereed papers

• Recent references from PubMed and VetMedResource.
• Franchitto N, Bloch J, Solal C; French PCC Research Group; Pélissier F (2022) Self-poisoning by e-cigarette and e-liquids: national reports to French Poison Control Centers from July 2019 to December 2020: VIGIlance
  and VAPE: the VIGIVAPE Study. Nicotine Tob Res ntad116 PubMed DOI: 10.1093/ntr/ntad116.
• Gordon T, Karey E, Rebuli M E, Escobar Y H, Jaspers I, Chen LC (2022) E-cigarette toxicology. Ann Rev Pharmacol Toxicol 62, 301-322 PubMed.
• Wang B, Liu ST, Johnson MA, Trigger S (2022) Trends and characteristics of ocular exposures related to e-cigarettes and e-liquids reported to Poison Control Centers in the United States, 2010-2019. Clin Toxicol 60(3), 279-285 PubMed.
• Mayer B (2014) How much nicotine kills a human? Tracing back the generally accepted lethal dose to
  dubious self-experiments in the nineteenth century. Archives of Toxicology 88(1), 5-7 PubMed.
• Haderdahl N C, Sereda C W (2004) The dangers of nicotine ingestion in dogs. Vet Med
  99(3), 218-224.

Other sources of information

• Bates N, Crouchley J, Edwards N (2015) Electronic cigarette ingestion in dogs [abstract]. Clinical
  Toxicology 53(4), 276
• Spoo W (2009) Nicotine toxicosis. In: Bonagura J D, Twedt D C (eds). Kirk’s Current Veterinary Therapy XIV.
  Saunders Elsevier: St Louis, Missouri, pp 135-138.

• ASPCA Animal Poison Control Center: www.aspca.org/pet-care/animal-poison-control, telephone
  +1 (888) 426-4435.
• Veterinary Poisons Information Service (VPIS): www.vpisglobal.com, telephone + 44 (0) 207
  3055055.