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E-cigarettes: an evidence update <br /> <br />64 <br />drank up to 1,500mg of nicotine in e-liquid, the result was vomiting and recovery within <br />a few hours [76]. One fatal outcome was recorded with 3,950mg of nicotine found in <br />gastric content. The victim seems to have drunk three vials of e-liquid totalling over <br />10,000mg of nicotine[76]. An intravenous injection of unknown quantity of e-liquid also <br />resulted in death [77]. <br /> <br />E-liquid normally comes in 10ml bottles containing up to 360mg of nicotine (see below). <br />This poses no risk to vapers if used as intended. The liquid however should be in <br />‘childproof’ packaging to prevent small children, who may find the flavouring appealing, <br />from drinking it. This seems to have been widely accepted by the EC industry. All e- <br />liquids we have seen so far in the UK and globally were sold in child-resistant <br />packaging. <br /> <br />Review methods <br />We searched the US National Library of Medicine (Pubmed) using the following search <br />terms: ((cotinine OR nicotine) AND (blood OR plasma OR urine OR saliva OR liquid OR <br />aerosol OR pharmacokinetic$)) AND (electronic cigarette$ OR e -cig$ OR ENDS). This <br />search returned 161 records. The abstracts of all records were screened. <br /> <br />Papers were included if they were peer-reviewed and presented data regarding nicotine <br />in e-liquid, aerosol, or body fluids (blood, saliva or urine). Studies that reported data on <br />blood, salivary, or urine cotinine were also included. <br /> <br />A total of 112 records were excluded as they did not contain any relevant information, <br />leaving 49 records. The full papers of these records were retrieved and reviewed. <br /> <br />From the full text review, 25 studies provided data regarding nicotine content of ambient <br />air, e-liquid and vapour, and 16 provided data on nicotine delivery to users. The <br />remaining eight papers did not contain any relevant information. Three further relevant <br />papers were published during the writing of this report and were also included. <br /> <br />Nicotine in ambient air, e-liquid and e-vapour <br />We identified five studies of nicotine in ambient air, 14 studies of nicotine in e -liquid and <br />nine studies of nicotine vapour. The results are summarised below. We tabulate the <br />results where appropriate and provide a narrative summary where there are only a fe w <br />studies available. Each section is concluded with a brief summary. <br /> <br />Passive vaping: Nicotine from e-cigarette use in ambient air <br />Four studies examined nicotine exposure from passive vaping. Long et al., 2014 <br />measured nicotine content of EC exhalations. EC exhalations contained eight times less