E-Cigarette Injuries On the Rise

Injuries from electronic cigarettes (e-cigarettes) are on the rise, which may pose a significant public health threat.

E-cigarettes are one of many types of electronic nicotine delivery systems (ENDS)— products that were largely unregulated until recently.

Effective August 8, 2016, the FDA requires the following regulations for ENDS sales:

  • Check photo ID of everyone under age 27 who attempts to purchase ENDS.
  • Only sell ENDS to customers aged 18 years and older.
  • Don’t give away free samples of ENDS, including their components and parts.
  • Don’t sell e-cigarettes in a vending machine unless in an adult-only facility.

The University of Washington Medical Center recently treated 15 patients with injuries from e-cigarette explosions resulting from the lithium-ion battery component.1 Injuries among patients included flame burns (80%), chemical burns (33%), and blast injuries (27%).1 Additionally, these injuries have resulted in various complications including tooth and soft tissue loss. Wound care, skin grafting, and surgery were required in many of the cases. Sites of injury included the face (20%), hands (33%), and thigh or groin (53%). Lithium-ion batteries found in e-cigarettes can overheat and explode, which is known as “thermal runaway.”

The American Association of Poison Control Centers (AAPCC) reports that in 2014 more than half of reported e-cigarette and liquid nicotine exposures occurred in children under 6 years of age.2 Some have required emergency room visits with nausea and vomiting among the most common symptoms. There have even been deaths associated with accidental ingestion. In 2016, through September 30, the AAPCC has received 1237 e-cigarette devices and liquid nicotine reported exposures across all age groups.2 Table 1 shows exposures from 2011 to 2016.

Table 1: E-Cigarette and Liquid Nicotine Exposures2


Number of Cases











2016 through September 30


*Adapted from the AAPCC Report

Pharmacists can play an important role in counseling patients on the dangers of e-cigarette products. Communitywide education especially among the youth is crucial. Let patients know to keep these products out of reach of children in a locked area. Remind individuals using these products to be aware that there is a risk of injury resulting from e-cigarette explosion. The FDA rule discusses that ENDS components including batteries are included in the regulation. However, it still remains unclear how the safety of the batteries will be monitored. Battery regulation and monitoring should be considered a top priority due to the rise in injuries related to e-cigarette explosions. It’s important to report any adverse events related to e-cigarettes to the FDA.


  • Brownson EG, et al. Explosion injuries from e-cigarettes. N Engl J Med. 2016;375:1400-1402.
  • The American Association of Poison Control Centers. E-cigarettes and liquid nicotine. aapcc.org/alerts/e-cigarettes/.