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The death of a man after a steam-related lung failure

"In just two days, he was no longer sick, but dead," recalled his father, Daniel Mitchell, as he struggled to grasp the unthinkable. "The doctor said he was dying, to be honest, I was preparing to have a funeral for my child, I was crying and crying for this kid."

Alexander Mitchell's doctors at a hospital in Payson, Utah, were stunned when the tests were negative for bacterial pneumonia and a variety of ailments. However, one study found that something unusual – evidence of abnormal immune cells in his lung – was generally associated with rare, potentially fatal, pneumonia in the elderly, who accidentally inhaled droplets of oil-based laxatives, such as mineral oil.

A doctor's clue would help save Mitchell's life. The young man's lungs had failed ̵

1; he had an acute respiratory distress syndrome, a life-threatening and often fatal lung injury. The doctor told the family that he suspected that the disease was related to Vaping after hearing of similar cases elsewhere. The Provo, Utah, husband, and his parents had mentioned using e-cigarettes. But until then nobody had connected the points. The doctors sent him to the University of Utah Hospital in Salt Lake City, 65 miles away, for the most up-to-date life support to maintain oxygen flow and heal his lungs.

Mitchell's Case Is One of the Most Common Degrees Among the vaping-related lung diseases currently under investigation by state and federal health authorities, doctors have seen at least 193 cases in 22 states, many of them adolescents and young adults. On Friday, Illinois health authorities announced the first known death from a steam-related lung disease in an adult. They refused to provide more details. Meanwhile, the state health authorities are reporting a growing number of cases.

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Video: Utah officials said they did not know if the diseases were related to their e-cigarette devices or certain ingredients or contaminants. (The Washington Post)

There are more questions than answers to lung diseases and their association with devices that have gained popularity despite little research into their long-term effects. E-cigarettes have been introduced to help smokers quit by quenching their craving for nicotine without lighting up. In teenagers and young adults, however, their consumption is now at an epidemic level.

The patients have various substances, including nicotine, evaporated marijuana-based products and "self-brewed" over various periods and in different places. Although the cases look similar, officials at the Centers for Disease Control and Prevention warn that the diseases are related to the e-cigarette devices themselves or to certain ingredients or contaminants inhaled through them. It is not even clear if they have a common cause or if they are different diseases with similar symptoms.

The severity of some of the illnesses in previously healthy young people has unsettled family members and even some doctors.

It is extremely alarming to see patients so sick, "said Sean Callahan, a pulmonary physician at the University of Utah.

Alexander Mitchell believed he had the flu when he had severe nausea, pain in the early summer However, he deteriorated so quickly that his parents and even the doctors were astonished.

The scariest moment may have come for his parents when doctors said their son's lung failure called for an additional aggressive life support machine called ECMO: The device pumps blood from the patient's body into an artificial lung that adds oxygen and removes carbon dioxide, replacing the function of one's own lungs, and sends the blood back to the patient.

"He had two Tubes, one dark red and the other bright red, "Daniel Mitchell recalled." The doctors said one-third of his blood was too white One time out of his system. "

  Alexander Mitchell, 20, of Provo, Utah, was one of five patients who were treated at the University of Utah Hospital for severe lung injury. He finally recovered. Family photo.

Alexander Mitchell, 20, of Provo, Utah, was one of five patients treated at the University of Utah Hospital for severe lung injury related to vaping. He finally recovered. Family photo.

When Alexander pulled out his hoses, they warned his parents, "He would be dead in 30 seconds and we could not do anything."

Doctors told the parents that he could need a lung transplant if he did so showed no improvement. But after about nine days, the life-sustaining machines made his lungs heal. He was able to go home on July 7th.

The University of Utah doctors, who have seen Mitchell in addition to four similar cases this summer, have their own theory about what could cause the steam-related illnesses.

They say a culprit may be the liquid commonly known as vapo juice, which is part of all e-cigarettes. The products are very different, but all contain a heating element that generates an aerosol from a liquid that the user inhales through a mouthpiece.

In some cases, the increase may be due to a substance recently added to the oils that is to be diluted or added, "said Scott Aberegg, a pulmonologist and specialist in critical care at the University of Utah, Mitchell and four others Patients in his hospital looked after and two more in another facility.

Some of the patients had been muffled for months and years. "So, if there had been an earlier accumulation of cases, we would have recognized them earlier."

Tracing the In some cases, however, it was difficult to obtain vapor liquid until it was purchased, with some patients claiming to have cartridges of ingredients purchased in other states, and one patient told the doctors he'd gotten his cartridges in Las Vegas and it turned out they had presumably to introduce THC, the main component of the mind-altering drugs Effects of marijuana, said Aberegg. THC is not legal in Utah.

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

When the fluid is heated, the resulting aerosol may contain fine and ultrafine toxic particles, including heavy metals, chemicals used for flavoring, such as diacetyl, associated with a severe lung disease, the so-called popcorn lung, and VOCs that last a long time

"We do not know whether it is propylene glycol or glycerol or other additives in the vaping fluids provided by the manufacturers, or those that occur in the US Combine with other adulterers, according to the Make when people add or mix them, "said Aberegg.

Some of the Utah patients had milder illnesses than Mitchell. But four of the five also had abnormal immune cells in their lung samples, Aberegg said. Such cells are indicators of a variety of diseases, including a rare disease known as lipoid pneumonia, which includes chest pain and breathing difficulties similar to the symptoms of bacterial pneumonia.

Immune cells in vaping-related diseases.

"In many cases, however, we have a high degree of confidence that these are not just associations, but vaping and everything contained in the products." Aberegg said. The abnormal cells could be a "very important marker of vapor-induced pneumonia" and "an important indication of what is going on".

Six weeks after hospital discharge, Mitchell resumed walking. But with a 25 percent reduction in lung capacity, it does not go as long or as often as it used to. He also fights with his short-term memory. Doctors say they are not sure if he will recover completely.

Doctors say that his youth was a deciding factor in his survival. "He was young, otherwise healthy and in good physical shape before the disease started," said Aberegg, one of about 20 clinicians who treated the young man.

Mitchell said he has little recollection of what happened during his time in the hospital because he spent most of his time in medically induced coma. But he's amazed that doctors attribute his near-death experience to vaping – a practice he started about two years ago because he did not want to use traditional cigarettes.

"It's getting healthier," he said.

Most of the time, he said he vapourized flavored nicotine products, but THC consumed a few times with friends, he said. None of them got sick.

In mid-June, Mitchell said he had bought another brand of Vaps juice – peach-menthol flavor – at his regular e-cigarette store and used it with the same e-cigarette device. It was the first time he used a well-known brand. The family did not want to identify it until the FDA makes further investigations. "It was a brand new box," Mitchell recalled. Inside, "the bottle had a seal."

He said he was steaming less than usual then. The next day, he felt sick and started his life-changing medical odyssey.

Adults can make decisions for themselves, Mitchell said. But he said his experience should be a warning of dangers that are not clearly formulated for steaming.

"I did not think it would make me literally lie on my deathbed," he said.

This article was written by Lena H. Sun, a Washington Post reporter.

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