A Surprisingly Volatile Smoking Alternative: Explosion and Burns as Risks of E-Cigarette Use

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An increasingly popular addition to the nicotine market, electronic cigarettes, or e-cigarettes’ smoking cessation value and device safety have been disputed. We recently treated a patient for burns sustained from an e-cigarette explosion.
A 30-year-old female was brought from an outside hospital to the University of Kentucky Emergency Department with 2% TBSA burns in her face, forearm, and thigh and bilateral corneal burns caused by e-cigarette explosion during use. She was intubated due to possible airway injury and transferred to our burn center. Bronchoscopy revealed bronchorrhea, but no other evidence of airway injury. She was hemodynamically stable with good oxygenation, and was subsequently extubated. She was treated with erythromycin to corneal burns, silvadene to the extremities, and bacitracin to the face. She was seen in the plastic surgery clinic 1 week out and was healing well.
E-cigarettes typically contain a lithium battery and an atomizer, which vaporizes the liquid. There are safety debates surrounding the regulation and risks of the liquid contents, or e-liquid, which can contain hazardous chemicals such as formaldehyde. One study demonstrated a risk of lipid pneumopathy with use of poorly refined e-liquid. Bronchoscopic finding of unusual bronchorrhea in this case raises concern that explosion of e-cigarettes may affect the tracheobronchial mucosa.
According to the US Fire Administration, nine of 25 e-cigarette explosions reported to the media between 2009 and August 2014 were associated with injuries. Combustion may be due to the heating element overheating or the lithium-ion battery, because most instances occurred while charging the device. Other risks include increased nicotine dependence and poisoning. Hundreds of cases have been reported of children treated for nicotine poisoning after ingesting e-liquid.
E-cigarettes have numerous potential health risks. It is important that the medical community is aware of these risks. As e-cigarette use grows, so will the occurrence of these adverse events.
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