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ObjectivesCarbon monoxide is a potentially fatal form of poisoning. The exact incidence is unclear, due to cases being undiagnosed or reported as fewer than the real number. Hyperbaric oxygen therapy (HBOT) is of proven efficacy in the treatment of CO intoxication.The purpose of this study was to describe the general characteristics of carbon monoxide (CO) intoxications presenting to the emergency department and to investigate troponin I values and the effectiveness of hyperbaric oxygen therapy (HBOT) in these patients.Material and methodsPatients presenting to the emergency department with CO intoxication over one year and patients with such intoxications receiving HBOT were examined retrospectively.ResultsOne hundred seventy-one patients were included; 140 (81.9%) were poisoned by stoves, 18 (10.5%) by hot water boilers and 10 in (5.8%) by fires. COHb levels were normal in 49 of the 163 patients whose values were investigated, and were elevated in 114 patients. Mean COHb value was 16.6. Troponin I values were investigated in 112 patients. These were normal in 86 patients and elevated in 26. Mean troponin I value was 0.38 ng/ml. One hundred twenty-three of the 171 patients in the study were discharged in a healthy condition after receiving normobaric oxygen therapy, while 48 patients received HBOT. Forty-two (87.5%) of the patients receiving HBOT were discharged in a healthy condition while sequelae persisted in five (10.4%). One patient died after 15 session of HBOT.ConclusionAlthough elevated carboxyhemoglobin confirms diagnosis of CO intoxication, normal levels do not exclude it. Troponin I levels may rise in CO intoxication. No significant relation was observed between carboxyhemoglobin and receipt of HBOT. A significant correlation was seen, however, between troponin I levels and receipt of HBOT.

The water pipe (narghile) in particular is widely used in the Arabian Peninsula and the Turkish world, and has also recently become an increasingly popular way of consuming tobacco in Europe. Contrary to popular belief, it contains more tar, carbon monoxide (CO) and toxic gases than cigarettes. This report describes a patient presenting to the emergency department with syncope as a result of water pipe use, with tests revealing toxically high CO levels.

Objectives: The aim of this experimental study was to investigate the effects of mad honey (grayanotoxin, GTX), used in complementary medicine for a variety of purposes besides being food, on pain thresholds in normal mice as model for acute pain and diabetic mouse as model for neuropathic pain. Methods: Hind paw withdrawal pain threshold to thermal stimulus was measured with a plantar analgesia meter in a mice model using healthy intact animals for acute pain and streptozotocin-induced diabetic animals for chronic neuropathic pain. Time and dose-dependent effects of intraperitoneally (i.p.) administered GTX were investigated in both acute and neuropathic pain. Results: In the acute pain model, administration of GTX caused a dose- and time-dependent marked increase in the pain latency values. In diabetic mice, which had markedly increased threshold to pain, GTX (0.1 mg/kg, i.p.) restored the mean pain latencies by decreasing from the pre-GTX treatment values of 3.2 ± 0.6 to 3.0 ± 0.9s at 10 min, 3.2 ± 0.6s at 20 min, 3.4 ± 0.6s at 30 min, 2.6 ± 0.5s at 60 min and 2.4 ± 0.6s ( p < 0.05) at 100 min. Conclusion: The results from this experimental study indicate that GTX exhibits significant analgesic activity and has potential benefits against painful diabetic neuropathy. This is compatible with the widespread use of GTX containing mad honey for alleviating pain. Further studies involving long-term applications are needed for a more decisive conclusion regarding the usefulness of GTX as an analgesic, especially in the treatment of painful neuropathy.

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The water pipe is a means of tobacco consumption widespread in Turkey and Arab countries. We present two patients brought to our emergency department due to a syncopal attack secondary to carbon monoxide toxicity following water pipe use. This rare form of poisoning should be borne in mind by emergency physicians as a differential diagnosis in water pipe smokers. Water pipes should be used where there is adequate ventilation.