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Try out PMC Labs and tell us what you think. Learn More. The extraction process yields a waxy substance that is heated, vaporized and inhaled.
We describe a lung injury as a result of BHO use. A ly healthy year-old female presented to the ED with shortness of breath for 3—4 days. She was refractory to bronchodilators, steroids and supplemental O 2. She has a 1-pack year smoking history and daily BHO abuse. Chest x-ray was positive for bilateral patchy infiltrates with mild hyperinflation. CT was negative for Pulmonary Embolus or other acute pathologic process. Sputum gram stain and blood cultures were negative.
On physical exam she was tachycardic and tachypneic. Respiratory auscultation showed decreased air entry bilaterally with diffuse expiratory wheezing, bilateral rhonchi and a prolonged expiratory phase. We concluded her severe pneumonitis was secondary to daily BHO inhalation. Methacrolein is structurally similar to acrolein, a pulmonary irritant, which causes acute lung injury and pulmonary edema in laboratory animals. We Is hash bad for your lungs a mechanism of lung injury and acute respiratory failure secondary to inhalation of high levels of methacrolein and benzene related to relatively novel phenomena of BHO use.
BHO is produced using liquid butane to extract high levels of THC from dried cannabis; the resulting product contains both butane and terpene byproducts. The extraction process yields a waxy substance that is then heated, Is hash bad for your lungs and subsequently inhaled.
We describe a case involving inhalation of BHO that lead to an acute lung injury in a patient presenting with symptoms of atypical pneumonia. A ly healthy year-old female presented to the Emergency Department with complaints of shortness of breath for 3—4 days.
She further complained of a productive cough, nausea and headache. She denied chest pain or fever. On physical exam she was noted to be tachycardic and tachypneic. Respiratory auscultation demonstrated decreased air entry with diffuse expiratory wheezing, bilateral rhonchi and a prolonged expiratory phase with obvious use of accessory respiratory muscles. She has a 1-pack year smoking history and stated she had smoked marijuana infrequently in the past.
She was admitted to a different hospital one month prior for similar symptoms. She was treated with breathing treatments, antibiotics, IV steroids and Tamiflu; although influenza titers were negative. Work up included a PA chest x-ray see Fig. Due to the severity of her respiratory distress a CT angiogram with PE protocol was completed; no evidence of a PE was found, however the scan demonstrated bilateral patchy infiltrates see Figs.
Initial labs revealed leukocytosis with a WBC count of Sputum gram stain and culture were negative. Arterial blood gases showed a pH of 7. Ongoing severe hypoxia prompted further work up of allergic bronchopulmonary aspergillosis ABPAalpha-1 antitrypsin deficiency, HIV Is hash bad for your lungs influenza; however, all tests were negative. A bronchoalveolar lavage BAL was not part of the workup, however if the patient showed s of lipoid pneumonia subacute onset with hemoptysis, chest pain, and fever or with markedly dense nodules on CT a BAL would be useful to exclude this diagnosis, characterized by lipid-laden macrophages.
Several days into the hospital stay, the patient elaborated further on her marijuana usage and stated she frequently inhaled vaporized marijuana in the form of Butane Hash Oil. She would inhale amounts approximate to 1g, 1—2 times per day and had been doing so for the past 3 years. She stated she inhaled BHO 1 week, or less, prior to each of her two hospital admissions. Severe pneumonitis with acute Is hash bad for your lungs respiratory failure secondary to Butane Hash Oil inhalation.
Dab, or dabbing, is the colloquial street term used by individuals that inhale butane hash oil, named in part to the small amount of BHO used each time. Our patient described the meticulous and very dangerous process of producing BHO. A filter is used at one end of the glass tube which entraps the large pieces of cannabis. This allows the liquid remnants of THC, one of the psycho-active ingredients in cannabis, and butane to pass into a bowl. The bowl is then placed on a hot surface to allow for the partial evaporation of the butane leaving behind a sticky brown substance, similar in texture to wax, which is then known as BHO.
When made illegally there are no guidelines that dictate an acceptable level of butane remaining in the product. A dab of BHO on the end of the metal wire would then be touched against the nail causing an instant vaporization. The heated vapor would then be inhaled through the top of the pipe. Methacrolein has been shown to be structurally similar to Acrolein, a powerful pulmonary irritant and carcinogen [ 3 ]. Studies have shown that high levels of Acrolein can lead to acute lung injury and pulmonary edema in laboratory animals [ 3 ].
At this temperature, there was likely an increased release of the pulmonary irritants Methacrolein and Benzene, as well as hot vapor [ 3 ]. The patient also stated the BHO was not purchased legally, indicating that the level of butane in the product was unknown.
There is a likely probability that a high level of inhaled butane also contributed to her symptoms. The only literature on this subject matter we could find involved a year-old male in whom was diagnosed with severe pneumonitis after inhalation of butane hash oil [ 5 ]. Commonalities in these two cases are summarized in Table 1case clinically more severe, both clinical courses were similar with response to respiratory support and steroids. Our case helps bring to light the lack of research involving the use of BHO and its acute and unknown long-term health effects. Our patient informed us that some individuals using BHO believe it is safer to use than smoking cannabis in a cigarette form.
Butane Hash Oil is an emerging popular trend because of its high percentage of THC consumed in just one inhalation. The lack of literature and research on this topic makes the short and long-term effects on individual health largely unknown. While our patient improved in the hospital with medical treatment, it is unknown if she will suffer any long-term permanent effects of inhaling hash oil containing butane and various byproducts of terpene. Lung injury, as a result of BHO inhalation, should be considered when a patient with a history of marijuana related drug use presents with symptoms similar to pneumonia.
Author names : Ryan P. National Center for Biotechnology InformationU. Respir Med Case Rep. Published online Jan 4. Ryan P. Author information Article notes Copyright and information Disclaimer. Anderson: ude. This article has been cited by other articles in PMC. Associated Data Supplementary Materials Multimedia component 1. Case A ly healthy year-old female presented to the ED with shortness of breath for 3—4 days. Case summary A ly healthy year-old female presented to the Emergency Department with complaints of shortness of breath for 3—4 days.
Open in a separate window. Computed Tomography Scan CT indicating patchy bilateral infiltrates. Posteroanterior PA Chest x-ray indicating mild hyperinflation. Diagnosis Severe pneumonitis with acute Is hash bad for your lungs respiratory failure secondary to Butane Hash Oil inhalation.
Discussion Dab, or dabbing, is the colloquial street term used by individuals that inhale butane hash oil, named in part to the small amount of BHO used each time. Table 1 Comparison of the two documented cases of lung injury secondary to BHO inhalation. Conclusion Butane Hash Oil is an emerging popular trend because of its high percentage of THC consumed in just one inhalation.
Appendix A. References 1. Stogner J. Toxicant formation in dabbing: the terpene story. ACS Omega. Farrer D. Oregon Health Authority; December.
McMahon M. Walter reed National medical Center. Severe pneumonitis after inhalation of butane hash oil. June 1, ; 13 6 [ PubMed ] [ Google Scholar ].Is hash bad for your lungs
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