Nicotine Toxicity Secondary to Aftermarket Modifications to a Vaping Device

Military Medicine ◽

10.1093/milmed/usab223 ◽

2021 ◽

Author(s):

Garrett S Bendel ◽

Hugh M Hiller ◽

Aaron Ralston

Keyword(s):

Emergency Department ◽

Cigarette Smoking ◽

Lung Injury ◽

Potential Risk ◽

Electronic Cigarettes ◽

Active Duty ◽

Safe Alternative ◽

Relative Ease ◽

Product Use

ABSTRACT Electronic cigarettes continue to rise in popularity as a reportedly safe alternative to standard cigarette smoking. Their use has become common in our society and specifically in our young active duty population. This cigarette smoking alternative has come under recent scrutiny with the discovery of e-cigarette or vaping product use-associated lung injury. However, there is another potential risk associated with vaping: the relative ease at which vaping devices can be modified has allowed a growing community of users to invent novel ways of delivering higher concentrations of nicotine. Here, we describe two cases of active duty patients who presented to an emergency department with clinical nicotine toxicity after using a heavily modified e-cigarette.

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Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury

Journal of Medical Toxicology ◽

10.1007/s13181-020-00772-w ◽

2020 ◽

Vol 16 (3) ◽

pp. 295-310 ◽

Cited By ~ 10

Author(s):

Dazhe James Cao ◽

Kim Aldy ◽

Stephanie Hsu ◽

Molly McGetrick ◽

Guido Verbeck ◽

...

Keyword(s):

Lung Injury ◽

Electronic Cigarettes ◽

Electronic Cigarette ◽

Health Consequences ◽

Product Use

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Chemical Constituents Involved in E-Cigarette, or Vaping Product Use-Associated Lung Injury (EVALI)

Toxics ◽

10.3390/toxics8020025 ◽

2020 ◽

Vol 8 (2) ◽

pp. 25 ◽

Cited By ~ 8

Author(s):

Thivanka Muthumalage ◽

Michelle R. Friedman ◽

Matthew D. McGraw ◽

Gary Ginsberg ◽

Alan E. Friedman ◽

...

Keyword(s):

Emergency Department ◽

Acute Lung Injury ◽

Lung Injury ◽

Chemical Constituents ◽

Underlying Disease ◽

Disease Mechanism ◽

Product Use ◽

Vitamin E Acetate ◽

High Incidence ◽

Conjugated Compounds

The Centers for Disease Control declared e-cigarette, or vaping, product use-associated lung injury (EVALI) a national outbreak due to the high incidence of emergency department admissions and deaths. We have identified chemical constituents in e-cig counterfeit cartridges and compared these to medical-grade and CBD containing cartridges. Apart from vitamin E acetate (VEA) and tetrahydrocannabinol (THC), other potential toxicants were identified including solvent-derived hydrocarbons, silicon conjugated compounds, various terpenes, pesticides/plasticizers/polycaprolactones, and metals. This study provides additional insights into the chemicals associated with EVALI cartridges and thus may contribute to the underlying disease mechanism of acute lung injury.

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Patterns of combustible and electronic cigarette use during pregnancy and associated pregnancy outcomes

Scientific Reports ◽

10.1038/s41598-021-92930-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Annette K. Regan ◽

Gavin Pereira

Keyword(s):

Cigarette Smoking ◽

Low Birthweight ◽

Electronic Cigarettes ◽

Cigarette Use ◽

Pregnancy Risk ◽

Safe Alternative ◽

Predictive Values ◽

Smoking During Pregnancy ◽

Quit Smoking ◽

Pregnant Smokers

AbstractAlthough pregnant smokers may perceive electronic cigarettes (e-cigarettes) as safe alternatives to smoking combustible cigarettes, few studies have evaluated perinatal e-cigarette use and its associated health effects. We analyzed data from the Pregnancy Risk Assessment Monitoring System (PRAMS, 2016–2018) for 16,022 women who recently gave birth and reported smoking combustible cigarettes prior to pregnancy. Using average marginal predictive values from multivariable logistic regression to produce adjusted prevalence ratios (aPRs), we estimated the prevalence of combustible cigarette smoking during pregnancy and adverse birth outcomes associated with e-cigarette use. In total, 14.8% of smoking women reported using e-cigarettes prior to pregnancy. There was no association between e-cigarette use prior to pregnancy and combustible cigarette smoking during pregnancy (aPR 0.95; 95% CI 0.88, 1.02); however, e-cigarette use during pregnancy was associated with higher prevalence of combustible cigarette smoking during pregnancy (aPR 1.65; 95% CI 1.52, 1.80). In this sample, we did not observe evidence to support reduced risk of preterm birth, small-for-gestational age and low birthweight compared to combustible cigarette smoking during pregnancy. The prevalence of LBW was higher for those who used e-cigarettes, even exclusively, compared to women who quit smoking cigarettes entirely. These results suggest that e-cigarettes should not be considered a safe alternative to combustible cigarette smoking during pregnancy.

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Electronic cigarettes and e-cigarette/vaping product use associated lung injury (EVALI)

Paediatric Respiratory Reviews ◽

10.1016/j.prrv.2020.06.003 ◽

2020 ◽

Vol 36 ◽

pp. 87-91 ◽

Cited By ~ 1

Author(s):

Meagan Shinbashi ◽

Bruce K. Rubin

Keyword(s):

Lung Injury ◽

Electronic Cigarettes ◽

Product Use

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E‐cigarette or vaping product use‐associated lung injury (EVALI) features and recognition in the emergency department

Journal of the American College of Emergency Physicians Open ◽

10.1002/emp2.12112 ◽

2020 ◽

Vol 1 (5) ◽

pp. 1090-1096

Author(s):

Kim Aldy ◽

Dazhe James Cao ◽

Mary Madison Weaver ◽

Devika Rao ◽

Sing‐Yi Feng

Keyword(s):

Emergency Department ◽

Lung Injury ◽

Product Use

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E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) in an Active Duty Service Member

Military Medicine ◽

10.1093/milmed/usaa349 ◽

2020 ◽

Author(s):

Michael T Colesar ◽

Daniel J McCollum

Keyword(s):

Infectious Disease ◽

Intensive Care Unit ◽

Acute Respiratory Distress Syndrome ◽

Lung Injury ◽

Distress Syndrome ◽

Armed Forces ◽

Active Duty ◽

Service Member ◽

Product Use

ABSTRACT E-cigarette or vaping product use-associated lung injury (EVALI) is a developing serious pulmonary disease associated with the increasing use of vaping products in both civilian and active duty populations. This case study describes an active duty trainee using unbranded vaping products who developed acute respiratory distress syndrome necessitating intubation and multiday intensive care unit hospitalization. Diffuse ground glass opacities in imaging, lipid-laden macrophages found on bronchoalveolar lavage, negative infectious disease workup, and recent vaping indicate EVALI. This case demonstrates more work needs to be done within the Armed Forces to reduce use of vaping products given the danger of EVALI.

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Toxicity From Blue Lotus (Nymphaea caerulea) After Ingestion or Inhalation: A Case Series

Military Medicine ◽

10.1093/milmed/usab328 ◽

2021 ◽

Author(s):

Mackenzie Schimpf ◽

Thomas Ulmer ◽

Hugh Hiller ◽

Alexander F Barbuto

Keyword(s):

Emergency Department ◽

Mental Status ◽

Plant Material ◽

Electronic Cigarettes ◽

Case Series ◽

Altered Mental Status ◽

Active Duty ◽

Lotus Flower ◽

Urine Drug ◽

High Doses

ABSTRACT Plant extracts and other novel psychoactives can be ingested, vaped, injected, or insufflated. This includes products such as extracts from the blue lotus flower (Nypmhaea caerulea), which is known to produce euphoria and hallucinations at high doses. Blue lotus is sold in several forms, including dried plant material, teas, and extracts for use in electronic cigarettes. Because newer generations of electronic cigarettes can deliver a variety of substances, practitioners need to be mindful of toxicity from a growing number of psychoactives, some of which are not detectable by standard urine drug screens. This case series describes five active duty patients who presented to the emergency department with altered mental status following the use of blue lotus products, four after vaping and one after making an infused beverage. Patients displayed similar symptoms, including sedation and perceptual disturbances. The patients in our series were successfully managed with supportive measures without the need for sedating agents. Recognizing and identifying new trends in substance use can help to provide directions in undifferentiated altered mental status.

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Google shopping queries for vaping products, JUUL and IQOS during the E-cigarette, or Vaping, product use Associated Lung Injury (EVALI) outbreak

Tobacco Control ◽

10.1136/tobaccocontrol-2021-056481 ◽

2021 ◽

pp. tobaccocontrol-2021-056481 ◽

Cited By ~ 1

Author(s):

Eric C Leas ◽

Natalie H Moy ◽

Alicia L Nobles ◽

John Ayers ◽

Shu-Hong Zhu ◽

...

Keyword(s):

Lung Injury ◽

Online Shopping ◽

Prediction Interval ◽

Moving Average ◽

Disease Outbreaks ◽

Safe Alternative ◽

Product Use ◽

Philip Morris ◽

Prior Approval ◽

Moving Average Model

ObjectivesTo assess whether the late 2019 US outbreak of pulmonary disease linked to vaping (‘E-cigarette, or Vaping, product use Associated Lung Injury’ (EVALI)) impacted online shopping queries for vaping products and the Philip Morris ‘IQO’ brand of heated tobacco.MethodsWe tracked online shopping queries for vape(s), JUUL and IQOS by analysing rates of Google queries indicative of shopping (eg, buy IQOS) after news of the outbreak was first reported (the week of 29 July 2019) until hospitalisations ceased (the week of 16 February 2020). We compared observed rates of shopping during the outbreak to counterfactual expected rates that were predicted using an autoregressive iterative moving average model fit to queries from 1 January 2014 to the week of 21 July 2019.ResultsDuring the outbreak, vape shopping queries were 34% (95% CI 30% to 38%) lower than expected and JUUL shopping queries were 39% (95% CI 34% to 45%) lower than expected, translating into about 7.2 and 1.0 million fewer searches. IQOS shopping queries were 58% (95% prediction interval (PI): 34–87) higher than expected, translating into 35 000 more searches. Moreover, IQOS shopping queries reached a historic high the week they were discussed as a potentially safe alternative to vaping (the week of 29 September 2019), when they were 382% (95% PI: 219–881) above expected rates for the week.ConclusionsThese results suggest that unplanned events, such as the EVALI outbreak, can provoke changes in the epidemiology of product usage. Tobacco companies should be prohibited from using events such as disease outbreaks to position their products as less harmful without prior approval.

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