Most people are familiar with e-cigarettes. New e-cigarette stores are popping up almost every day. City councils around the country are debating the pros and cons of setting age limits to buy them and banning them in places where smoking cigarettes is already forbidden.
There's another e-cigarettes related story that's is much more alarming that is beginning to surface - the potentially deadly liquids that are often bought and used to refill the e-cigarette vaporizer.
These "e-liquids," the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.
According to an article in The New York Times, e-liquids are being mixed on factory floors and in the back rooms of shops.
Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.
Many users, unaware of the toxicity of the ingredients, are casually leaving replacement bottles around the house where children are finding and ingesting them.
"It's not a matter of if a child will be seriously poisoned or killed," said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. "It's a matter of when."
Nationwide, the number of poison cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals - triple the previous year's number.
As two examples, of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year, involved children age 4 and under. That age group is considered typical.
The e-liquids are much more dangerous than tobacco because liquid is absorbed quickly into the skin, even in diluted concentrations. Initially, many of the e-cigarette brands were disposable devices that looked like regular cigarettes. However, many of the newer e-cigarette vaporizers are larger and can be refilled with liquid that is generally nicotine, flavorings and solvents.
Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The FDA has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue.
Chip Paul, chief executive officer of Palm Beach Vapors, a company that operates 13 e-cigarette franchises, estimates that there will be sales of one to two millions liters of liquid used to refill e-cigarettes.
If you look online, you can buy e-liquids anywhere from a liter to 55 gallon containers with 10 percent nicotine concentration.
Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, "are selling liquid and they don't have a clue what is in it."
The nicotine levels in e-liquids can vary. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet.
A lethal dose at such levels would take "less than a tablespoon," according to Dr. Cantrell, from the poison control system in California. "Not just a kid. One tablespoon could kill an adult," he said.
Many people believe that e-cigarettes are a new and valuable tool in the battle to quit smoking. The science isn't there yet to say whether they actually help or just replace conventional cigarette addiction. But one thing is for sure, if you have e-cigarettes and in particular, e-liquid refill containers in the home, they should be kept out of a child's eyesight and reach.