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Arena C, Scaduto F, Principe S, Benfante A, Messina R, La Sala A, Serafino Agrusa L, Martorana A, Cabibi D, Solidoro P, Scichilone N. Fever and dyspnoea in a tracheostomised patient. Breathe (Sheff) 2020; 16:200115. [PMID: 33447286 PMCID: PMC7792835 DOI: 10.1183/20734735.0115-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Pneumonia of unknown origin in tracheostomised patienthttps://bit.ly/3hZHBA0
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Duffy B, Li L, Lu S, Durocher L, Dittmar M, Delaney-Baldwin E, Panawennage D, LeMaster D, Navarette K, Spink D. Analysis of Cannabinoid-Containing Fluids in Illicit Vaping Cartridges Recovered from Pulmonary Injury Patients: Identification of Vitamin E Acetate as a Major Diluent. TOXICS 2020; 8:E8. [PMID: 31991538 PMCID: PMC7151740 DOI: 10.3390/toxics8010008] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/15/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023]
Abstract
Beginning in June of 2019, there was a marked increase in reported cases of serious pulmonary injury associated with vaping. The condition, referred to as e-cigarette or vaping product use-associated lung injury (EVALI), does not appear to involve an infectious agent; rather, a chemical adulterant or contaminant in vaping fluids is suspected. In August of 2019, the Wadsworth Center began receiving vaporizer cartridges recovered from patients with EVALI for analysis. Having no a priori information of what might be in the cartridges, we employed untargeted analyses using gas chromatography-mass spectrometry and high-resolution mass spectrometry to identify components of concern. Additionally, we employed targeted analyses used for New York medical marijuana products. Here, we report on the analyses of 38 samples from the first 10 New York cases of EVALI for which we obtained cartridges. The illicit fluids had relatively low cannabinoid content, sometimes with unusual Δ9-/Δ8-tetrahydrocannabinol ratios, sometimes containing pesticides and many containing diluents. A notable diluent was α-tocopheryl acetate (vitamin E acetate; VEA), which was found in 64% of the cannabinoid-containing fluids. To investigate potential sources of the VEA, we analyzed six commercial cannabis-oil diluents/thickeners. Three were found to be >95% VEA, two were found to be primarily squalane, and one was primarily α-bisabolol. The cause(s) of EVALI is unknown. VEA and squalane are components of some personal care products; however, there is growing concern that vaping large amounts of these compounds is not safe.
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Affiliation(s)
- Bryan Duffy
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Lingyun Li
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Shijun Lu
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
| | - Lorie Durocher
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Mark Dittmar
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Emily Delaney-Baldwin
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - Deepika Panawennage
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
| | - David LeMaster
- Laboratory of Molecular Diagnostics, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA;
| | - Kristen Navarette
- Center for Environmental Health, New York State Department of Health, Albany, NY 12201, USA;
- Albany Medical Center, Department of Pediatrics, Albany, NY 12208, USA
| | - David Spink
- Laboratory of Organic Analytical Chemistry, Wadsworth Center, New York State Department of Health, Albany, NY 12201, USA; (B.D.); (L.L.); (S.L.); (L.D.); (M.D.); (E.D.-B.); (D.P.)
- Department of Environmental Health Sciences, School of Public Health, University at Albany, State University of New York, Rensselaer, NY 12144, USA
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