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Brush of one person with death after pulmonary insufficiency related to vaping

Within days, Alexander Mitchell passed from a 20-year-old hobbyist to being kept alive by two machines that let air in and out of his lungs and oxygenate his blood outside his body.

"He went from being sick to being at the door of death literally in two days," recalled Father Daniel Mitchell as he struggled to grasp the unthinkable. "The doctor said he was dying. Frankly, I was planning to plan my kid's funeral. I cried and cried for this boy."

Alexander Mitchell's doctors at a hospital in Payson, Utah, were confused when tests came back negative for bacterial pneumonia and many common ailments. However, one exam raised something unusual ̵

1; evidence of abnormal immune cells in his lungs – usually associated with the rare, potentially deadly pneumonia seen in older people who occasionally inhale drops of oil-based laxatives like mineral oil.

The lull will help save Mitchell's life. The young man's lungs had failed – he had acute respiratory distress syndrome, a life-threatening and often fatal lung injury. The doctor told the family that he suspected the condition was related to vaping after hearing about similar cases elsewhere. The man from Provo, Utah and his parents had mentioned that he used electronic cigarettes. But until then no one had connected the dots. Doctors had taken him to the University of Utah Hospital in Salt Lake City, 65 miles, so they could provide him with the most advanced support for life to keep the flow of oxygen and allow his lungs to heal.

Mitchell's case is among the most serious doctors observed among pulmonary-related lung diseases now investigated by state and federal health officials – at least 193 cases in 22 countries, many involving teens and young adults. On Friday, Illinois health officials announced the first known death from a vaping-related lung disease in an adult. They declined to provide further details. In the meantime, public health agencies are reporting an increasing number of cases.

There are more questions than answers about lung diseases and their relationship with devices that have grown in popularity, despite little study of their long-term effects. E-cigarettes were introduced as a way to help smokers quit by satisfying their nicotine cravings without burning themselves, but their use is already at epidemic levels among teenagers and young adults.

Those who have become ill have cooked a variety of substances, including nicotine-based marijuana products, and make "home-cooked" cooks of varying lengths and places. Although the cases appear to be similar, staff at the Centers for Disease Control and Prevention are careful not to know if the diseases are related to the electronic cigarette devices themselves or to the specific ingredients or pollutants that are inhaled through them. It is not clear even if they have a common cause or whether they may be different diseases with similar symptoms.

The severity of some illnesses in previously healthy young people has unrestrained family members and even some physicians.

"To see patients who are sick is extremely disturbing," says Sean Callahan, a pulmonologist at the University of Utah.

Alexander Mitchell thought he had the flu when he woke up earlier this summer with severe nausea, chest pain and breathing problems. But it got so bad that his parents, and then even the doctors, were surprised.

Perhaps the most frightening moment for his parents was when doctors said their son's lung deficiency required an additional aggressive life support machine known as ECMO. The machine pumps blood from the patient's body into an artificial lung, which adds oxygen and removes carbon dioxide, replacing the function of the human lungs. The machine then sends the blood back to the patient.

"There were two tubes of it, one was dark red and the other was bright red," recalls Daniel Mitchell. "Doctors said one-third of his blood came out of his system at any time.

If Alexander removed his tubes, they warned his parents," he'll be dead in 30 seconds and there's nothing we can do. "

Doctors told his parents that he might need a lung transplant if he did not show improvement. But after about nine days, the life-support machines allowed his lungs to heal. He was able to return home on July 7th.

University of Utah doctors who saw Mitchell, in addition to four similar cases this summer, have their own theory of what could be the cause of the vaping diseases.

They say one culprit can to be the liquid commonly known as lime juice, which is k The products are significantly different, but they all contain a heating element that produces an aerosol from a liquid that consumers inhale through a mouthpiece.

The impact on cases may be the result of something recently added to the oils " dilute or add to them. "says Scott Aberg, a pulmonologist and critical care specialist at the University of Utah who cared for Mitchell and four patients at his hospital and consulted the other two at another facility.

Some patients were vaped for months and months. years, he said, so if there was a previous cluster of cases, "we would have recognized it sooner."

Tracking the discharge fluid to where it was purchased, however, is difficult in some cases. that they buy cartridges containing ingredients in other countries, and one patient told doctors that and They seem to have opened, probably introducing THC, the main ingredient that produces mind-altering effects of marijuana, said Abereg. THC is not legal in Utah.

Vaping fluid may contain nicotine, flavors, propylene glycol, vegetable glycerin and other ingredients, according to the Food and Drug Administration, which regulates tobacco products, including e-cigarettes.

When the liquid is heated, the resulting aerosol may contain fine and ultra-fine toxic particles, including heavy metals, chemicals used for flavoring, such as diacetyl, associated with a serious pulmonary disease known as popcorn lung, and volatile organic compounds that can cause long-term health effects, including cancer, according to the 2016 American Surgeon General's Report

"We do not know if this is propylene glycol or glycerol or other supplements in vaginal fluids placed there manufacturers, or those things in combination with other adulterers, after production, when people add or mix them, "says Abereg.

Some Utah patients had milder illnesses than Mitchell's. But four of the five also They have abnormal immune cells in their lungs, Aberg said, "such cells are indicators of various diseases, including a rare condition known as lipoid pneumonia, whose symptoms include chest pain and difficulty breathing – similar to the symptoms of bacterial pneumonia.

Aberg warned that he remained very unknown about what was causing the abnormal.

But "in many cases, we have a high level of confidence that what we are dealing with is not just an association, it's caused by vaping and what's been in the products," said Abereg. Abnormal cells can be "a very important marker for vaping-related pneumonia" and "an important key to what is happening."

Six weeks after leaving the hospital, Mitchell resumed tourism. But with lung capacity reduced by 25 percent, he does not walk as long or as often as before. He also struggles with his short-term memory. Doctors say they are not sure if it will fully recover.

Doctors say that his youth was a decisive factor in his survival. "He was young, otherwise healthy and in good physical condition before the onset of the disease," says Aberg, one of about 20 clinicians who treat the young man.

Mitchell said he remembered a little about what happened while he was in the hospital, as he had been in a medically induced coma for much of the time. He is stunned, however, by doctors attributing his near-death experience to vaping – a practice he started about two years ago because he wanted to give up conventional cigarettes.

"Promoted as healthier," he said.

Mostly he said he had used flavored nicotine products but had used THC several times with friends, he said. None of them got sick.

In mid-June, Mitchell says he bought a different brand of vape juice – peach menthol – from his regular vape shop and uses it with his same electronic cigarette device. For the first time, he uses a well-known brand. The family doesn't want to identify him until the FDA investigates further. "It was a whole new box," Mitchell recalled. Inside "the bottle is sealed."

He said it had fallen less than usual at the time. The next day he became ill and began his life-changing medical odyssey.

Adults can make decisions for themselves, Mitchell said. But he said his experience should be a warning of dangers not explicitly stated in connection with vaping.

"I didn't think it would cause me to be literally on my bed," he said.

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Alice The Post of Washington Post contributed to this report.

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