9 ms·

Several things have failed to show up in the comments that might illuminate this discussion. (1) The condition is called lipoid pneumonia, which comes from inh

Several things have failed to show up in the comments that might illuminate this discussion. (1) The condition is called lipoid pneumonia, which comes from inhaling organic fats and oils. (2) The CDC reports and early studies indicate that the condition has appeared in some people who only vaped with nicotine in glycerol (which is also sometimes called glycerin or glycerine). (3) Glycerol (the Christmas molecule--HO HO HO) is a type of alcohol called a polyol, meaning that it has multiple (in this case, three) hydroxyl groups on a carbon chain. (4) Glycerol is not a fat and cannot be responsible, on its own, for lipoid pneumonia. (5) However, glycerol is the precursor to fat synthesis in the body: triglycerides, for example, are fats metabolized from glycerol. (6) The reaction of glycerol -> triglycerides in the body is catalyzed by nicotine-containing enzymes mostly present in the liver, but expressed to a lesser extent in every cell. (7) The reaction of carboxylic acid (derived from CO2) with glycerol creates fatty acid esters through the process of acid-catalyzed esterification. (8) The key unanswered question is where does the fat that is found in the macrophages (a type of white blood cell whose function is to engulf and digest foreign substances) that is the sine qua non of lipoid pneumonia come from. (9) Many vapers are formerly heavy smokers, meaning that they have some degree of chronic lung disease, that they retain CO2, and are very likely to have respiratory acidosis. (10) Elevated CO2 also occurs in many other circumstances, such as opioid use and sleeping in poorly ventilated conditions. (11) If the early reports are correct that lipoid pneumonia is occurring in vapers who have only used nicotine in glycerol with no flavoring or impurities, then we must ask the question: Is glycerol being converted to fatty acids in lung cells by NAD-mediated enzymatic conversion or acid-catalyzed esterification in the presence of high CO2 levels and acidity?

protonimitate 7y ago
I think >(9) Many vapers are formerly heavy smokers, meaning that they have some degree of chronic lung disease, that they retain CO2, and are very likely to have respiratory acidosis. Is important to add to the discussions. A lot of articles are pointing the finger at THC carts. They may be the catalyst but according to this NEJM article[0]: >About 80% of the persons who vaped and became ill reported having used both nicotine products and tetrahydrocannabinol (THC) or cannabidiol (CBD) products. That's for 215 acute cases and 2 deaths that they cited. [0]https://www.nejm.org/doi/full/10.1056/NEJMe1912032 https://www.nejm.org/doi/full/10.1056/NEJMe1912032
- lonelappde 7y ago
  lifetime smoking history is a major confounder that needs to be measured and highlighted.
lonelappde 7y ago
> nicotine-containing enzymes mostly present in the liver Nicotine from ingested smokee/vape/tobacco, or from other natural human physiology?
- shpongled 7y ago
  They are probably talking about nicotinamide adenine dinucleotide (NAD+/NADH), a common cofactor used in redox reactions. While nicotinamide the word appeads similar to nicotine, they are in fact completely different chemicals... There are no "nicotine-containing enzymes" in the human body.
zelon88 7y ago
> (3) The CDC reports and early studies indicate that the condition has appeared in some people who only vaped with nicotine in glycerol (which is also sometimes called glycerin or glycerine). Are you sure? The article states ... "...most of the afflicted users reported using THC exclusively or as well as nicotine."
- mistermann 7y ago
  The information and wording used in these reports seems designed to maximize fear, but more importantly, maximize uncertainty, confusion, and speculative discussion. From the TechCrunch article: > One trend worth noting, however, is that very few of the cases involve only nicotine products You'd have to read these articles very carefully to discern that. > ...most of the afflicted users reported using THC exclusively or as well as nicotine. Ditto. If this is such a serious public health risk (as it seems to be, with more than one death involved so far), why the weasely language, why is this being communicated exclusively through the use of ambiguous terms like "some", "most", "associated with", etc? > While many of the patients, but not all, reported recent use of THC-containing products, some reported using both THC- and nicotine-containing products. A smaller group reported using nicotine only. "A smaller group reported using nicotine only" - how much smaller? Technically speaking, two people is a group, and is smaller than say 400. Every official news release I've read on this (with the exception of one or more from particular state-level medical organizations) is written in this manner, a maximization of uncertainty and confusion, but with every single sentence being technically correct if taken literally as written. This is plausible deniability done right. Why don't they simply publish a concise table of data that unambiguously states the actual numbers that they have in their possession (otherwise, how would they make these statements), but instead choose to take the far more laborious approach of describing that data, and in unclear and extremely ambiguous terms?
  - kaikai 7y ago
    They currently have a small and changing dataset. These are news articles, not peer-reviewed scientific papers. When researchers publish datasets it’s to back up conclusions that they’ve made based on the data, and in this case they haven’t reached conclusions. Implying otherwise to the public would be irresponsible.
robocat 7y ago
> (11) If the early reports are correct that lipoid pneumonia is occurring in vapers who have only used nicotine in glycerol with no flavoring or impurities, then we must ask the question: Is glycerol being converted to fatty acids in lung cells by NAD-mediated enzymatic conversion or acid-catalyzed esterification in the presence of high CO2 levels and acidity? How about also asking another question: do some people using cannabis "dank" vapes lie? Police, perception, insurance: three good reasons cannabis smokers wouldn't give the truth and might just say they smoked nicotine.
- ineedasername 7y ago
  I think that needs to be weighed against the fact that it seems unlikely 1) everyone would lie and 2) they would lie regarding a health issue that has killed people, meaning they have a strong interest in doctors having accurate information so it doesn't kill them too
  - robocat 7y ago
    > it seems unlikely 1) everyone would lie From the article "One trend worth noting, however, is that very few of the cases involve only nicotine products; most of the afflicted users reported using THC exclusively or as well as nicotine." I struggle to see why GP is completely ignoring this and is insinuating that normal nicotine vaping is dangerous. It is fabulously unlikely we have only just "discovered" this. Instead, something has changed, and that has been detected. I worry because there seems to be a very strong media campaign of "don't vape nicotine", when the facts I have read say "don't vape THC carts". I imagine that there is an argument that it is safer to be over-cautious, but it also discourages smokers from converting to vaping. Vaping is not healthy, but it seems to be far healthier than smoking. I have very clearly seen the health positives of vaping within my own social circle. Maybe there is no disinformation campaign, but something seems majorly weird about this topic. Disclaimer: never smoked nor vaped.
    - sharkmerry 7y ago
      I just see a general "dont vape" trend and that is good. Until we know more, lay off.
otakucode 7y ago
Whatever the cause, it has to be something extremely subtle and very unlikely to occur. We know that from the simple numbers. Tens of millions of people vaping on an hourly basis for years amounting to ~500 cases means that whatever is occurring is a freak occurrence and not some direct consequence that has a high likelihood of occurring in typical people.
- metamet 7y ago
  And isn't one of the common threads within this whole thing the presence of Vitamin E acetate within the oil? Earlier reports were suggesting that contaminated oils may be part of the cause, which could explain why all these cases are hitting at once. Not sure on the process of making these oils, but I could see new methods being introduced causing unforeseen side affects.
  - davinic 7y ago
    The initial NY report mentioned also that they were likely counterfeit products, which I could easily see as being prone to use an unsafe substitution.
- brandonmenc 7y ago
  > Tens of millions of people vaping on an hourly basis for years amounting to ~500 cases Vaping is new. Maybe these are the early incidents of a yet-to-be-discovered chronic condition that takes a decade plus of vaping to develop. Hey, millions of high schoolers smoke cigarettes and none of them have lung cancer! (yet)
  - chrshawkes 7y ago
    18 and 19 year olds are in commas, dead right now, or will be soon. This is killing people far faster than cigarettes. I'm of the opinion the small fraction of people claiming they only smoked nicotine are probably lying for reasons mentioned before. They are young kids who don't want to disappoint their families with the fact that they are now dying at a very young age from what used to be a mostly harmless activity (marijuana smoking). There are also settlements and insurance including life insurance, AD & D to consider as well. Juul Lab's and all the vaping shops need to be put out of business for claiming this is a harmless way of smoking. Kids took that and ran with it as they vaporize God knows what to get high in a stealthy and supposedly, more healthy way.
kylek 7y ago
Not a chemist so looking for a little clarification. The typical "base liquids" (that nicotine is suspended in) are vegetable glycerin ("VG") and propylene glycol ("PG"). When you say "glycerol", which exactly are you referring to? (Or is it both?) (VG makes the larger "clouds" that some people prefer, typically with lower nicotine concentrations. PG is much less visible and dissipates quicker, but some people consider it a little more harsh, regardless of nicotine concentration)
- PeanutNore 7y ago
  Glycerol is glycerin, glycerin is glycerol - it's mainly a matter of UK (glycerol) vs. US (glycerin) terminology.

protonimitate 7y ago

I think >(9) Many vapers are formerly heavy smokers, meaning that they have some degree of chronic lung disease, that they retain CO2, and are very likely to have respiratory acidosis. Is important to add to the discussions. A lot of articles are pointing the finger at THC carts. They may be the catalyst but according to this NEJM article[0]: >About 80% of the persons who vaped and became ill reported having used both nicotine products and tetrahydrocannabinol (THC) or cannabidiol (CBD) products. That's for 215 acute cases and 2 deaths that they cited. [0]https://www.nejm.org/doi/full/10.1056/NEJMe1912032 https://www.nejm.org/doi/full/10.1056/NEJMe1912032

lonelappde 7y ago
lifetime smoking history is a major confounder that needs to be measured and highlighted.

lonelappde 7y ago

> nicotine-containing enzymes mostly present in the liver Nicotine from ingested smokee/vape/tobacco, or from other natural human physiology?

shpongled 7y ago
They are probably talking about nicotinamide adenine dinucleotide (NAD+/NADH), a common cofactor used in redox reactions. While nicotinamide the word appeads similar to nicotine, they are in fact completely different chemicals... There are no "nicotine-containing enzymes" in the human body.

zelon88 7y ago

> (3) The CDC reports and early studies indicate that the condition has appeared in some people who only vaped with nicotine in glycerol (which is also sometimes called glycerin or glycerine). Are you sure? The article states ... "...most of the afflicted users reported using THC exclusively or as well as nicotine."

mistermann 7y ago
The information and wording used in these reports seems designed to maximize fear, but more importantly, maximize uncertainty, confusion, and speculative discussion. From the TechCrunch article: > One trend worth noting, however, is that very few of the cases involve only nicotine products You'd have to read these articles very carefully to discern that. > ...most of the afflicted users reported using THC exclusively or as well as nicotine. Ditto. If this is such a serious public health risk (as it seems to be, with more than one death involved so far), why the weasely language, why is this being communicated exclusively through the use of ambiguous terms like "some", "most", "associated with", etc? > While many of the patients, but not all, reported recent use of THC-containing products, some reported using both THC- and nicotine-containing products. A smaller group reported using nicotine only. "A smaller group reported using nicotine only" - how much smaller? Technically speaking, two people is a group, and is smaller than say 400. Every official news release I've read on this (with the exception of one or more from particular state-level medical organizations) is written in this manner, a maximization of uncertainty and confusion, but with every single sentence being technically correct if taken literally as written. This is plausible deniability done right. Why don't they simply publish a concise table of data that unambiguously states the actual numbers that they have in their possession (otherwise, how would they make these statements), but instead choose to take the far more laborious approach of describing that data, and in unclear and extremely ambiguous terms?
- kaikai 7y ago
  They currently have a small and changing dataset. These are news articles, not peer-reviewed scientific papers. When researchers publish datasets it’s to back up conclusions that they’ve made based on the data, and in this case they haven’t reached conclusions. Implying otherwise to the public would be irresponsible.

robocat 7y ago

> (11) If the early reports are correct that lipoid pneumonia is occurring in vapers who have only used nicotine in glycerol with no flavoring or impurities, then we must ask the question: Is glycerol being converted to fatty acids in lung cells by NAD-mediated enzymatic conversion or acid-catalyzed esterification in the presence of high CO2 levels and acidity? How about also asking another question: do some people using cannabis "dank" vapes lie? Police, perception, insurance: three good reasons cannabis smokers wouldn't give the truth and might just say they smoked nicotine.

ineedasername 7y ago
I think that needs to be weighed against the fact that it seems unlikely 1) everyone would lie and 2) they would lie regarding a health issue that has killed people, meaning they have a strong interest in doctors having accurate information so it doesn't kill them too
- robocat 7y ago
  > it seems unlikely 1) everyone would lie From the article "One trend worth noting, however, is that very few of the cases involve only nicotine products; most of the afflicted users reported using THC exclusively or as well as nicotine." I struggle to see why GP is completely ignoring this and is insinuating that normal nicotine vaping is dangerous. It is fabulously unlikely we have only just "discovered" this. Instead, something has changed, and that has been detected. I worry because there seems to be a very strong media campaign of "don't vape nicotine", when the facts I have read say "don't vape THC carts". I imagine that there is an argument that it is safer to be over-cautious, but it also discourages smokers from converting to vaping. Vaping is not healthy, but it seems to be far healthier than smoking. I have very clearly seen the health positives of vaping within my own social circle. Maybe there is no disinformation campaign, but something seems majorly weird about this topic. Disclaimer: never smoked nor vaped.
  - sharkmerry 7y ago
    I just see a general "dont vape" trend and that is good. Until we know more, lay off.

otakucode 7y ago

Whatever the cause, it has to be something extremely subtle and very unlikely to occur. We know that from the simple numbers. Tens of millions of people vaping on an hourly basis for years amounting to ~500 cases means that whatever is occurring is a freak occurrence and not some direct consequence that has a high likelihood of occurring in typical people.

metamet 7y ago
And isn't one of the common threads within this whole thing the presence of Vitamin E acetate within the oil? Earlier reports were suggesting that contaminated oils may be part of the cause, which could explain why all these cases are hitting at once. Not sure on the process of making these oils, but I could see new methods being introduced causing unforeseen side affects.
- davinic 7y ago
  The initial NY report mentioned also that they were likely counterfeit products, which I could easily see as being prone to use an unsafe substitution.
brandonmenc 7y ago
> Tens of millions of people vaping on an hourly basis for years amounting to ~500 cases Vaping is new. Maybe these are the early incidents of a yet-to-be-discovered chronic condition that takes a decade plus of vaping to develop. Hey, millions of high schoolers smoke cigarettes and none of them have lung cancer! (yet)
- chrshawkes 7y ago
  18 and 19 year olds are in commas, dead right now, or will be soon. This is killing people far faster than cigarettes. I'm of the opinion the small fraction of people claiming they only smoked nicotine are probably lying for reasons mentioned before. They are young kids who don't want to disappoint their families with the fact that they are now dying at a very young age from what used to be a mostly harmless activity (marijuana smoking). There are also settlements and insurance including life insurance, AD & D to consider as well. Juul Lab's and all the vaping shops need to be put out of business for claiming this is a harmless way of smoking. Kids took that and ran with it as they vaporize God knows what to get high in a stealthy and supposedly, more healthy way.

kylek 7y ago

Not a chemist so looking for a little clarification. The typical "base liquids" (that nicotine is suspended in) are vegetable glycerin ("VG") and propylene glycol ("PG"). When you say "glycerol", which exactly are you referring to? (Or is it both?) (VG makes the larger "clouds" that some people prefer, typically with lower nicotine concentrations. PG is much less visible and dissipates quicker, but some people consider it a little more harsh, regardless of nicotine concentration)

PeanutNore 7y ago
Glycerol is glycerin, glycerin is glycerol - it's mainly a matter of UK (glycerol) vs. US (glycerin) terminology.