Hidden Dangers of E-Cigs

By Tarah Damask. Medically reviewed by Tom Iarocci, MD. May 7th 2016

E-cigarettes have given hope to a variety of people as a way to provide consumers with a smokeless, tobacco-free alternative to conventional cigarettes.

Supporters of the ever-expanding trend boast the seemingly obvious benefits of “vaping” with e-cigarettes, including minimizing secondhand smoke and the lack of traditional carcinogens found in tobacco. The FDA has only recently taken an interest in e-cigarettes, so health risks are still not well known. Although e-cigarettes may end up helping people quit, similarly to nicotine gum and patches, there are concerns about the risks of e-cigs themselves.

A giant leap in e-cigarette-related calls to poison control centers suggests serious dangers that may be worth considering. According to the Centers for Disease Control, e-cigarette-related calls increased from one per month in September 2010 to 215 each month by February 2014.

Nicotine is Still an Issue

While proponents of the e-cigarette point to the absence of tobacco smoke
(the main culprit in smoking-related disease), the lack of tobacco toxins doesn’t mean “vaping,” or using e-cigarettes, is safe. To start with, e-cigarettes still deliver nicotine, an addictive drug, to the user. Vaping comes from the way e-cigs work – through a vapor version of smoke – when e-cigarettes function properly, their mechanisms heat the nicotine-containing liquid, resulting in vapor.

According to Dr. Shannon Clark, obstetrician/gynecologist and assistant professor of maternal-fetal medicine at the University of Texas Medical Branch, “Hypothetically, nicotine by itself, depending on how much an individual uses, can have a negative effect.” Since e-cigs do still deliver nicotine, they still pose a health risk.

Some evidence suggests nicotine on its own may even be involved in the development and growth of lung cancer and, at certain doses, may factor into cardiac arrest and stroke. While individuals who vape will not expose themselves to the carcinogens and toxins in tobacco smoke, additional ingredients found in varying concentrations in e-juice (the liquid that gets vaporized in an e-cigarette) have the potential for causing both long- and short-term health hazards.

Numerous studies, like one performed by the University of California, Riverside, reveal that manufacturers’ labels do not necessarily match up with the nicotine levels found in each e-cigarette. While FDA-approved products must deliver a specified dose range, the vaping devices are unregulated and may deliver widely varying doses. According to the Harvard Medical School, a study performed by the FDA revealed doses of nicotine ranging from 26.8 to 43.2 micrograms in several puffs from a single e-cig. Inhaling such unexpectedly large doses may result in nausea and vomiting.

Other Dangers of E-Cigs

Researchers at the Center for Tobacco Control Research and Education, University of California, San Francisco (UCSF), report that, contrary to beliefs that e-cigs contain water vapor and nicotine alone, the vapor you inhale also may contain toxins and even metals. During the heating process, atomizers composed of various metals may release metal particles, including nickel, lead and chromium. Chemicals that are delivered by different brands of e-cigarettes are starting to be investigated, but potential health risks are not known.

According to UCSF, researchers have found that unregulated e-juice may contain a variety of toxins, including the following nine compounds on California’s Proposition 65 list (the Safe Drinking Water and Toxic Enforcement Act of 1986), a compilation of carcinogens and toxins known to cause cancer or reproductive problems: acetaldehyde, cadmium, formaldehyde, isoprene, lead, nickel, nicotine, n-nitrosonornicotine and toluene.  

There also have been reports of e-cig malfunctions resulting in explosions and serious burns.

Fatal Side Effects of E-Cigarette Handling

Even if you follow e-cig instructions carefully, accidents may occur. Poisoning due to e-cigarettes can quickly claim the lives of adults, children and pets.

Because e-juice contains liquid nicotine, those handling the liquid are at risk of becoming exposed to highly concentrated levels of the drug, which is quite toxic. Accidentally drinking even half a mouthful of liquid nicotine may result in death. And direct ingestion is only one risk factor. Simply spilling e-juice on your hand or rubbing your eyes with fingers contaminated by e-juice can be enough to cause a severe reaction.

According to the Centers for Disease Control, nicotine poisoning may occur by ingestion, inhalation or absorption through skin or eyes. Even lower levels of nicotine can result in increased heartbeat, seizures and vomiting, and ingestion of

e-juice may cause gastrointestinal disturbance, respiratory failure and even death.

Reducing Your Risks

Studies on the effects of long-term e-cigarette use are limited. If you have considered e-cigarettes as a means of quitting or cutting down on smoking, you might be better off with other forms of nicotine replacement.

Nicotine inhalers, gum and patches have a track record, which helps in making a more-informed decision. For now, many authorities recommend avoiding e-cigarettes until the science, standards and regulations are in place to help ensure their safety and efficacy.

Next Steps

  • If you use e-cigarettes and have children or pets in your home, keep all parts of the e-cig out of reach to prevent accidental injury.
  • Protect yourself from accidental spills by wearing gloves while refilling an e-cig atomizer. Wash your hands with soap and water afterward and avoid touching your eyes or skin when handing e-juice.
  • If you are exposed to an excessive amount of e-juice, contact a poison control center or 911 immediately. 


Clark, S., MD, ob/gyn and assistant professor of maternal-fetal medicine at the University of Texas Medical Branch. http://www.utmb.edu/obgyn/MeetFaculty.htm. Interviewed June 2014.
American Lung Association. “American Lung Association Statement on E-Cigarettes.” http://www.lung.org/stop-smoking/tobacco-control-advocacy/federal/e-cigarettes.html. Accessed June 2014.
American Cancer Society. “Study compares e-cigarettes to quit-smoking aids.” http://www.cancer.org/cancer/news/studycomparese-cigarettestoquit-smokingaids. Accessed June 2014.
Glantz S., PhD. “Nine chemicals identified so far in e-cig vapor that are on the California Prop 65 list of carcinogens and reproductive toxins.” Center for Tobacco Control Research and Education, University of California, San Francisco. July 2013. http://www.tobacco.ucsf.edu/9-chemicals-identified-so-far-e-cig-vapor-are-california-prop-65-list-carcinogens-and-reproductive-t. Accessed June 2014.
Simon H., MD. “Electronic Cigarettes: Help or Hazard?” Harvard Medical School. September 2011. http://www.health.harvard.edu/blog/electronic-cigarettes-help-or-hazard-201109223395. Accessed June 2014.
Bassett R., DO, Osterhoudt K., MD, Brabazon T., DO. “Nicotine Poisoning in an Infant.” http://www.nejm.org/doi/full/10.1056/NEJMc1403843. Accessed June 2014.
Centers for Disease Control and Prevention. “New CDC Study Finds Dramatic Increase in E-Cigarette-Related Calls to Poison Centers.” New England Journal of Medicine. May 2014. http://www.cdc.gov/media/releases/2014/p0403-e-cigarette-poison.html. Accessed June 2014.
Davis B., BS, Dang M., BS, Kim J., BS, Talbot P. PhD. “Nicotine Concentrations in Electronic Cigarette Refills and Do-It-Yourself Fluids.” Department of Cell Biology and Neuroscience, University of California, Riverside. April 2014. 

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