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Essentials of Diagnosis
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Presentation is nonspecific
Illness is usually subacute
Respiratory, gastrointestinal, and constitutional symptoms are common
Tachycardia and tachypnea may also be present
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General Considerations
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No single causative agent has been identified
Most cases involve vaping products containing tetrahydrocannabinol (THC) or nicotine or both
Postulated factors contributing to the development of EVALI include
E-cigarette flavorings
Exposure to diacetyl (a popcorn flavoring that has been associated with lung injury)
THC
Adulteration of THC
Adulteration of delivery devices
Vitamin E acetate (used as a thickening agent)
Given the nonspecific nature of the presentation, especially during the influenza season and the COVID-19 pandemic, providers must have a high degree of clinical suspicion and ask patients specifically about vaping
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Respiratory symptoms (95%), including
Cough
Shortness of breath
Chest pain
Hemoptysis
Gastrointestinal symptoms (77%), including
Constitutional symptoms (85%), including
Tachycardia (55%) and tachypnea (45%)
Of note, 57% of patients have a recorded room air oxygen saturation of < 95%
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Differential Diagnosis
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Community-acquired pneumonia
COVID-19 (can be detected by reverse-transcription polymerase chain reaction (RT-PCR) testing of respiratory tract secretions, ie, expectorated sputum, nasopharyngeal swab or bronchoalveolar lavage specimens)
Acute eosinophilic pneumonia
Acute respiratory distress syndrome
Hypersensitivity pneumonitis
Lipoid pneumonia
Organizing pneumonia
Influenza (can be detected by RT-PCR testing of respiratory tract secretions, including nasopharyngeal washings, in season)
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No laboratory findings are specific for diagnosis of EVALI
Leukocytosis
Elevated C-reactive protein
Elevated erythrocyte sedimentation rate
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Symptoms of fatigue, dyspnea, decreased exercise capacity, and cough may persist for months
Over 95% of reported cases required hospitalization: 47% were admitted to intensive care, 22% were intubated and many died
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Jonas
AM
et al. Vaping-related acute parenchymal lung injury: a systematic review. Chest. 2020;158:155.
[PubMed: 32442559]
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Park
JA
et al. Vaping and lung inflammation and injury. Annu Rev Physiol. 2022;84:611.
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