vitamin-e acetate and additives sometimes used in THC and other vaping products may
be the culprit and vaping related lung diseases at least according to the CDC these lung injuries
have been so severe that it's actually caused a few dozen people to die as of the other day the
CDC said it's aware of 2051 cases of lung injury linked to vaping in 49 states all states except
for Alaska well I can tell you that the number is now at least 2053 because we just reported
two new cases to the city when we say acute lung injury that's a very broad medical diagnosis it
involves nasty inflammation within the lungs and can often lead to lung scarring it's caused by
lots of different things for example transfusion of blood products especially transfusion of fresh
frozen plasma or FFP for short so when someone gets acute lung injury from transfusion of FFP
we call that trolley or tra li transfusion related acute lung injury acute lung injury
has a spectrum of severity and if it's severe enough it's called a RTS meaning a respiratory
distress syndrome which I actually did a video on as well well when the hue lung injury is caused
by e-cigarettes or vaping it's called a valley or e cigarette or vaping product use associated
lung injury for short so a recent patient of mine who was an 18 year old male came to the hospital
after experiencing shortness of breath chest pain low-grade fever nausea vomiting a little bit of
abdominal cramping and some diarrhea as it turns out he was vaping THC he told me that he vaped
joule although I did not ask what the specific flavor was when he arrived to the hospital his
oxygen levels were okay but not great let's put it this way they were bad enough to require an oxygen
facemask so let's take a look at his chest x-ray but first let's see what a normal chest x-ray
looks like okay so we are looking at an x-ray of a young male patient probably late teens early 20s
mid 30s so this is a normal chest x-ray what we're looking at here is the heart and then here would
be the aorta this is the patient's right side this is the patient's left side so this would
be right long as to be his left lung this is the trachea here which splits at the karana into the
right mainstem bronchus and left mainstem bronchus these are the ribs coming out here you see where
the wherever there's air that's going to be the lung parenchyma so that's the lung tissue that's
there and normally that's going to be black in appearance which represents air so this is
a normal chest x-ray lungs look normal there's no fluid within the lungs and there's no fluid
outside of the lungs in the pleural space there's no plural of pleural effusion here there's no
pleural effusion here so this is a normal-looking chest x-ray and this is what his chest x-ray it
looked like when he first came to the hospital and this is when he was getting worse okay so this is
the chest x-ray of my patient he actually had two chest x-rays one was on day one the second one
was on day three also on day one he had a cat scan which we'll get to in a little bit so this is his
heart right here right here you see all this kind of fluffiness this fluffy white stuff here okay
that represents edema that could be cardiogenic edema or non cryogenic edema but this is pulmonary
edema meaning there's fluids and or inflammation building up within the lungs and if it starts
accumulating in the interstitial spaces meaning in between the alveoli but also at least partially
filling the alveoli themselves looks like you have a little bit on this side but it's definitely more
prominent on the left side here so what's going on in the lungs here so because he was also having
abdominal symptoms not only did he have low-grade fevers with a cough and shortness of breath and
chest pain but he also had some abdominal pain along with nausea vomiting and diarrhea so that's
why when it came into the ER they ordered a cat scan and this is normal one print comma
and here this white stuff here is definitely alveolar filling at least partial filling if not
complete filling of alveoli that are within this space whatever the causes it induces this crazy
chaotic inflammatory response within the lungs in this chaos there's damage to the alveoli and
the surrounding capillaries which leads to excess protein and fluid accumulation and interstitial
and alveolar spaces that means there's decreased lung compliance increased VQ mismatch and
increases in shunt and dead space ventilation ultimately this impairs the lungs ability to
get oxygen into the blood and not that you would lab see someone with air to yes but if you did the
histology would show diffuse alveolar damage okay so back to my patient by day two and day three
post vaping he continued to have worsening oxygen levels in the hospital and this was
despite him getting IV solu-medrol to suppress the inflammation and he was visibly working harder and
harder to move air in and out of his lungs so this is the third day of his symptoms the third day of
him being in the hospital you can see that there's way more whiteness in this lung compared to this
lung all this black is the air and all this white it represents fluid and or inflammation so this
is pulmonary edema and because we're saying that this is from vaping that's gonna be considered
a non cardiogenic pulmonary edema definitely a little bit some here but not it's definitely not
as much as this left lung here and his worsening oxygen levels correlated with his worsening chest
x-ray thankfully he didn't have a pneumothorax which sometimes these patients get regardless
if you brought him to the ICU and put a BiPAP mask on him which is essentially a last-ditch
effort to help with the breathing I told him that if his breathing doesn't improve with the
BiPAP mask he would require a breathing tube and be on a ventilator this is what a lot of other
young people who vaped also required fortunately he started to slowly improve and didn't require
breathing - this is not his x-ray but sometimes the lung injury from vaping can progress to a
RDS and this is a example of a RDS here so you can see that there's white fluffy infiltrates on both
sides of the lungs pretty extensive only a little bit of air that you can see in these lungs so this
is pretty much fluid filled inflammatory filled lungs that you're seeing what's interesting and
very scary is that we still don't know for sure what the cause is vitamin D along with vitamin
A D and K are fat soluble vitamins fat soluble vitamins are able to easily pass through the
cell membranes of the body unlike non fat soluble vitamins for example vitamin B vitamin E acetate
is used in nutritional supplements and skin creams and are not safe to inhale but this fat soluble
vitamin is added to some THC vaping liquids to help with THC absorption in the alveoli at least
in theory although there could be other chemicals causing the lung damage the only culprit right
now is the vitamin D acetate but it's still an ongoing investigation and because all this is so
new we don't know the underlying pathophysiology of this disease which also means we don't have
any Studies on treatment options we typically give corticosteroids such as solu-medrol in this case
to patients who have severe inflammation and based on the vaping cases that are out there
it seems to be effective but steroids have a ton of potential side effects so that is why
we only use them if you really have to of course an ounce of prevention is worth the pond of here
so the best solution is not vaping in the first place especially vaping THC and especially if
you're a teenager or a young adult just the other day Jewell said it stopped online sales of mint
julep odds the company said it will only sell Virginia tobacco classic tobacco and menthol
flavors in the US and get this investigations have also found many of the THC products people
reported using where THC cartridges which were bought through black-market sources but it might
be from some legitimate sources too as more states and federal government consider banning flavored
nicotine thousands of vapors are figuring out online how to make a liquids at home and this
just came out today now this was just in the news today the first double lung transplant due to a
vaping this was done at a hospital in Michigan I believe in Detroit so what we're looking at
here so this is a cat scan and this is a chest x-ray so again not exactly comparing apples to
apples because a cat scan is a higher resolution picture of a chest x-ray but what you're looking
at here is before the lung transplant so this patients original lungs there's hardly any air
in his lungs this is his trachea which divides into his right mainstem his left mainstem here
and as his bronchial tree you can see there's little bits of air in his bronchial tree but
essentially no air within his lungs themselves maybe a little bit here but that's about it so
this is after the lung transplant you can see yes chest tubes that's because whenever they do the
surgery the lungs collapse or the collapse so they have to put in the chest tube so that they stay
inflated and this is only a temporary measure but you could see it is way more black meaning
there's way more air in these lungs here there's two new studies that are showing that vaping is
just as harmful if not more harmful for the heart and smoking is one study showed that vapors had
higher levels of LDL cholesterol compared with smokers the other study showed that the heart's
ability to pump blood was diminished compared to smokers this was diminished not only at rest but
also during exercise but all I can tell you for sure is that putting a bunch of foreign chemicals
in your lungs is not a good idea but I don't think you need a lung doctor to tell you that