04-23-18 What is JUULing?

Toxicology Question of the Week

April 23, 2018

What Is “JUUL”ing?

School is in session: JUULing 101

Within the last five years, poison centers have seen spikes in nicotine exposures due to the increasing popularity of e-cigarettes and e-juices. These exposures typically occur in young children under the age of five, but recently new e-cigarette designs have posed new risks for an unconventional age group. Teens across the United States are experiencing symptoms of nicotine toxicity during school hours from “JUULing”. The JUUL® is the newest development in “smokeless tobacco” or “cigarette alternatives”. Nicknamed the “ipod” of smoking, the JUUL ® is an electronic cigarette that resembles a USB travel drive in size and look. With a USB charging piece, these electronic cigarettes charge by a magnetic piece connected to a USB that plugged into a laptop. These products are often mistaken as USB travel drives making identification of the contraband difficult for educators. 

The product seems to be popular among high school and middle school age children. This is likely due to the sleek and subtle design, as well as the flavorings offered. The JUUL® e-cigarette cartridges contain up to 50mg of nicotine, equaling approximately one full pack of cigarettes. As teenagers seek a nicotine buzz, they discretely use the device repeatedly, ingesting toxic amounts of nicotine, resulting in nausea, vomiting, tachycardic dysrhythmias, and potentially seizures with large exposures.

Treatment of nicotine toxicity includes symptomatic and supportive care, often requiring benzodiazepines for tachycardic dysrhythmias or seizures. Antiemetics may be required to mediate GI symptoms related to nicotinic and muscarinic activation by nicotine. With good quality supportive care by healthcare professionals, patients tolerate exposures and return to baseline within 24 hours.

 If you have questions about nicotine exposures, please call your local poison center at 1-800-222-1222 for recommendations any time of day.

This Question was prepared by Nena Bowman, PharmD, DABAT, and Managing Director at the Tennessee Poison Center.

I am interested in any questions you would like answered in the Question of the Week.  Please email me with any suggestion at donna.seger@vanderbilt.edu

Donna Seger, MD

Medical Director

Tennessee Poison Center

www.tnpoisoncenter.org

Poison Help Hotline: 1-800-222-1222

The Question of the Week is available on our website: www.tnpoisoncenter.org