Image A shows bronchoalveolar lavage fluid from an intubated patient with severe lung injury due to electronic cigarette and vaping-associated lung injury which required extracorporeal support. Note the congealed mass, which based on color and viscosity likely represents bronchial deposits of vitamin E acetate.

Vitamin E acetate in bronchoalveolar lavage fluid has been identified by investigators at the Centers for Disease Control and Prevention as a potential cause of the acute lung injury in critically ill patients with electronic cigarette and vaping-associated lung injury. Vitamin E acetate is a known diluent in nonregulated and illicit tetrahydrocannabinol, the psychotropic agent in marijuana–vape cartridges. Vitamin E acetate has gained popularity as an additive since late 2018 because of its color and viscosity, which mimic that of tetrahydrocannabinol. In contrast, vitamin E acetate has not been found in nicotine...

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