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Attorneys At Law www . FridayFirm . com yses , vitamin E acetate was found in 94 % of 51 EVALI-patient bronchoalveolar lavage ( BAL ) samples and in THC-containing e-cigarette , or vaping , products from 81 % of patients . 9 , 10 Vitamin E acetate was not found in BAL specimens from people without EVALI . 9 Further implicating vitamin E acetate as a toxicant causing EVALI , media sources have reported vitamin E acetate being sold on the internet beginning in late 2018 or early 2019 as a diluent-thickener for illicit THC-containing e-cigarette , or vaping , product liquids . 11 Additionally , analyses of THC-containing products seized by law enforcement in Minnesota revealed presence of vitamin E acetate in products confiscated during 2019 , but not in products confiscated in 2018 . 12 Although vitamin E acetate is strongly associated with EVALI , current evidence is not sufficient to rule out the contribution of other toxicants or chemicals of concern , including chemicals in either THC-containing or nicotine-containing products , in some of the reported EVALI cases .
Consistent with data from Illinois and Wisconsin , approximately 17 % of Arkansas EVALI patients denied THC product use in an e-cigarette , or vaping , device during the 90 days preceding illness onset . 1 Therefore , EVALI should still be considered as a possible diagnosis among patients with compatible clinical symptoms who deny using THC-containing EVPs . Clinicians should continue to advise against the use of nicotine- or THC-containing EVPs by youths , young adults , or pregnant women and advocate avoidance of THC-containing EVPs for all persons , particularly those acquired from informal sources .
ADH will continue to investigate cases of EVALI and asks that providers report suspected cases to the Outbreak Response Section at 501- 537-8969 . To receive timely , updated information on outbreak response activities , clinicians are encouraged to enroll in the voluntary Health Alert Network on the ADH webpage ( https :// hanregistration . adh . arkansas . gov /).
References
1 . Ghinai , I . et al . E-cigarette Product Use , or Vaping , Among Persons with Associated Lung Injury - Illinois and Wisconsin , April-September 2019 . MMWR Morb Mortal Wkly Rep 68 , 865- 869 , doi : 10.15585 / mmwr . mm6839e2 ( 2019 ).
2 . The Centers for Disease Control and Prevention . Severe Pulmonary Disease Associated with Using E-Cigarette Products , < https :// emergency . cdc . gov / han / han00421 . asp > ( 2019 ).
3 . Arkansas Department of Health . Arkansas Health Alert Network ( HAN ), < https :// www . healthy . arkansas . gov / programs-services / topics / arkansas-health-alert-network-han > ( 2020 ).
4 . The Centers for Disease Control and Prevention . 2019 Lung Injury Surveillance Primary Case Definition ( CDC ) – September 18 , 2019 , < https :// www . cdc . gov / tobacco / basic _ information / e-cigarettes / severe-lung-disease / health-departments / index . html # primary-case-def > ( 2019 ).
5 . Centers for Disease Control and Prevention . Outbreak of Lung Injury Associated with the Use of E-Cigarette , or Vaping , Products , < https :// www . cdc . gov / tobacco / basic _ information / e-cigarettes / severe-lung-disease . html > ( 2020 ).
6 . Krishnasamy , V . P . et al . Update : Characteristics of a Nationwide Outbreak of E-cigarette , or Vaping , Product Use-Associated Lung Injury - United States , August 2019-January 2020 . MMWR Morb Mortal Wkly Rep 69 , 90-94 , doi : 10.15585 / mmwr . mm6903e2 ( 2020 ).
7 . Armatas , C ., Heinzerling , A . & Wilken , J . A . Notes from the Field : E-cigarette , or Vaping , Product Use-Associated Lung Injury Cases During the COVID-19 Response - California , 2020 . MMWR Morb Mortal Wkly Rep 69 , 801- 802 , doi : 10.15585 / mmwr . mm6925a5 ( 2020 ).
8 . The Centers for Disease Control and Prevention . Outbreak of Lung Injury Associated with the Use of E-Cigarette , or Vaping , Products : For Healthcare Providers , < https :// www . cdc . gov / tobacco / basic _ information / e-cigarettes / severe-lung-disease / healthcare-providers / index . html > ( 2020 ).
9 . Blount , B . C . et al . Vitamin E Acetate in Bronchoalveolar-Lavage Fluid Associated with EVALI . N Engl J Med 382 , 697-705 , doi : 10.1056 / NEJMoa1916433 ( 2020 ).
10 . U . S . Food and Drug Administration . Lung Injuries Associated with Use of Vaping Products , < https :// www . fda . gov / news-events / public-health-focus / lung-injuries-associated-use-vaping-products > ( 2020 ).
11 . Downs , D ., Howard , D . & Barcott , B . Journey of a tainted vape cartridge : from China ’ s labs to your lungs . Leafly ( 2019 ). < https :// www . leafly . com / news / politics / vape-pen-injury-supply-chain-investigation-leafly >.
12 . Taylor , J . et al . Characteristics of E-cigarette , or Vaping , Products Used by Patients with Associated Lung Injury and Products Seized by Law Enforcement - Minnesota , 2018 and 2019 . MMWR Morb Mortal Wkly Rep 68 , 1096-1100 , doi : 10.15585 / mmwr . mm6847e1 ( 2019 ).
112 • The Journal of the Arkansas Medical Society www . ArkMed . org