special subjects
Vaping
Complications of vaping
Potential complications include Use ofnicotineby nonsmokers, leading tonicotineaddiction Pulmonary complications One concern is that nonsmokers, particularly adolescents, who inhalenicotine, become addicted. Certain substances in the vapor appear to lead to severe pulmonary injury. As of November 1, 2019, over 2000 cases of lung injury associated with e-cigarette or vapor use have been reported. The majority of reported cases are in young males who inhaled THC orcannabidiol-containing products. Chemicals and adulterants, particularlyvitamin Eacetate, are the most likely causative agents. Patients present with respiratory symptoms, gastrointestinal symptoms (pain), or other constitutional symptoms within 90 days after e-cigarette or vapor use. Subjective fever is the most common complaint. Patients may be tachycardic, tachypneic, or hypoxic. The condition may progress to Acute Hypoxemic Respiratory Failure (AHRF, ARDS) . The diagnosis is made by history of recent e-cigarette or vapor use and exclusion of other cause of lung injuries (eg, infection). Laboratory test may show leukocytosis with eosinophilia. Imaging studies of the lungs show bilateral lung opacities, most clearly seen with CT scan. Treatment is supportive, and patients may require intubation, mechanical ventilation, and extracorporeal membrane oxygenation. Administration of high-dose glucocorticoids (eg,methylprednisolone100 to 500 mg daily) has been suggested as beneficial, but evidence is sparse and it is not routinely recommended. 