ST. PAUL — Four cases of severe lung injury in Minnesota that may be related to vaping have state health officials concerned that what’s been billed by some as a relatively harmless substitution for smoking has hidden dangers, especially among young people.

E-cigarettes, vapes, e-pipes and other vaping products are battery-powered devices that allow users to inhale aerosolized liquid called juice, which typically contains nicotine and various flavorings.

In the Twin Cities, Children’s Minnesota Hospitals and Clinics has reported four cases in which the teenage patients, who used e-cigarettes, were hospitalized for weeks, some in intensive care, all with respiratory issues.

“These cases are extremely complex to diagnose, as symptoms can mimic a common infection yet can lead to severe complications and extended hospitalization,” Dr. Emily Chapman, chief medical officer at Children’s Minnesota, said in a Tuesday statement issued by the Minnesota Department of Health. “Medical attention is essential; respiratory conditions can continue to decline without proper treatment.”

The Health Department said product names are unknown and that both nicotine and marijuana vaping were reported by patients.

Symptoms include shortness of breath, fever, cough, vomiting, diarrhea, headache, dizziness and chest pain.

It's not just Minnesota

Officials aren’t sure if the cases are a direct result of vaping, or if vaping contributed in some way, but the rising number of similar cases from other states may indicate a pattern.

The Wisconsin Department of Health Services reported 12 confirmed cases and 13 under investigation of people with severe lung disease who all reported recent vaping or dabbing (which is vaping marijuana oils, extracts or concentrates).

The cases initially included only teens and young adults, but there are now cases in older age groups.

“All patients reported vaping prior to their hospitalization, but we don’t know all the products they used at this time,” said Andrea Palm, spokeswoman for the Wisconsin agency. “The products used could include a number of substances, including nicotine, THC, synthetic cannabinoids, or a combination of these.”

In an Aug. 9 press release, the Illinois Department of Public Health reported six cases in which the patients, described as “young,” experienced severe breathing problems after vaping. Five more cases are under investigation.

“The short-and long-term effects of vaping are still being researched,” said Illinois Department of Public Health Director Ngozi Ezike, “but these recent hospitalizations have shown that there is the potential for immediate health consequences.”

The current recourse for the health departments is data gathering by asking health care providers to report cases of severe lung disease that involve vaping. Users of vaping products who who are experiencing lung symptoms should stop using the devices and seek clinical care.

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One man's story

On July 21, Dylan Nelson, 26, of Burlington, Wis., opened a new e-cig vial and took a few hits. Shortly after, he began to feel ill. He developed a fever and spent a restless night, tossing, turning and sweating.

At 6 a.m., his sister took him to the emergency room. Twelve hours later, he was in a coma.

“He just kept getting worse and worse,” said his brother Patrick DeGrave, who spent the next week by his bedside wondering if he would live or die.

“His lungs began filling up with fluid,” DeGrave said. “They were running tubes down his mouth and throat into his lungs. They drained multiple canisters of fluid from his lungs. The doctor said his heart looked like the heart of a 65- to 70-year-old person.”

Nelson ran a continuous fever sometimes as high as 104 degrees. DeGrave would wipe his forehead, and within 10 seconds, he said, his brother’s head looked like it had been dunked in water.

“I had to start preparing for the worst,” he said. “I would ask the doctors, ‘Is my brother going to make it out of here?'” He was told, “We can’t be sure”; “It doesn’t look good”; and “If you’re a religious person, now would be a good time to start praying.”

After a day in a coma, the doctors tried reviving him, but his heart started beating so wildly, they sedated him, fearing blood clots would cause other damage.

Two days later, he woke up and by the end of a week, he was able to leave the hospital.

DeGrave’s theory is his brother just got a bad vial. He didn’t think it was an accumulation of vaping, as some have suggested.

What he did learn, however, is that his brother’s experience is part of a much larger problem.

After his brother’s story appeared in a Wisconsin newspaper, he began getting Facebook messages and texts from people all over the U.S. and Canada with similar stories.

“You name it, I have heard the story from, I’d say over 100 people, all from vaping,” he said. “It’s absolutely nuts.”

One man was messaging him while he was being treated at the hospital, relaying to his doctors what DeGrave’s brother’s doctors had told him.

Harmful ingredients

The U.S. surgeon general calls teen e-cigarette use an epidemic. Locally, the 2017 Minnesota Youth Tobacco Survey found that nearly 20 percent of high school students use e-cigarettes and 40 percent have tried them. Youth e-cigarette use has surpassed conventional cigarettes as the most commonly used tobacco product category among youth.

E-cigarette aerosol contains harmful chemicals, such as ultrafine particles, oil, heavy metals like nickel, tin and lead and other cancer-causing chemicals, according to the Minnesota Department of Health.

Among Minnesota high school students, e-cigarette use is now double conventional cigarette use. Those containing nicotine are considered harmful to the adolescent brain, affecting learning, memory and attention span.

Nearly 6 percent of adults currently use e-cigarettes, compared with less than 2 percent in 2010; and, nearly 13 percent of adults age 18-24 use e-cigarettes. The use of multiple tobacco products is common: 37 percent of adult e-cigarette users also use conventional cigarettes.

Beginning on Aug. 1, Minnesota law prohibited the use of e-cigarettes indoors where cigarette smoking is prohibited, including bars and restaurants.

Still better than smoking?

Sutao McCann, part owner of E-cig Xcape, a vaping store in Eagan, said she finds it hard to believe the lung disease is related to vaping.

She opened her store six years ago to help smokers quit and said she’s never had any customers get sick. Rather, she wonders if the recent lung issues aren’t an allergic reaction certain people are having with ingredients in the “juice.”

“With e-cigs you can control the level of nicotine and can cut it down to zero,” she said. “My regulars say they feel so much better.”

The mention of marijuana and THC in the reports riled her.

“If you are using other things in the device, we don’t consider it vaping,” she said. “If you’re using it to heat up marijuana or THC, you’re not vaping, you’re just doing drugs.”

She’s not allowed to sell to teens younger than 18, but she’s seen them try to get their older friends to buy for them. As if to make her point, on Tuesday, a young man and teen girl entered the store. He was old enough; she wasn’t. McCann made her wait by the door.

“Is vaping good for you?” McCann asked. “I say no. If you’re not smoking, don’t start. But if you are a smoker, this helps.”

According to CBS News, an executive at e-cigarette giant Juul Labs said after the Wisconsin cases that its vaping devices were developed for adult smokers who want to stop, not for underage users.