Carbon monoxide poisoning in narghile (water pipe) tobacco smokers

Abstract

Narghile (water pipe, hookah, shisha, goza, hubble bubble, argeela) is a traditional method of tobacco use. In recent years, its use has increased worldwide, especially among young people. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide (CO). We present an acutely confused adolescent patient who had CO poisoning after narghile tobacco smoking. She presented with syncope and a carboxyhemoglobin level of 24% and was treated with hyperbaric oxygen. Five additional cases of CO poisoning after narghile smoking were identified during a literature search, with carboxyhemoglobin levels of 20 to 30%. Each patient was treated with oxygen supplementation and did well clinically. In light of the increasing popularity of narghile smoking, young patients presenting with unexplained confusion or nonspecific neurologic symptoms should be asked specifically about this exposure, followed by carboxyhemoglobin measurement.

Carbonmonoxide Intoxication After Narghile Smoking: Two Case Presentations

“…Bazı genç içicilerde nargilenin sigaradan daha az zararlı olduğu inanışı vardır, bunun sebebi koku ve tadının daha çekici olması da olabilir. 1,5 Ek olarak nargilenin kullanıldığı ortamların sigaraya göre daha az zararlı olduğu hissi de uyandırabilmektedir. Nargile içimine bağlı CO intoksikasyonu olguları-ki genelde yirmili yaşlardadır-özellikle kış aylarında, baş ağrısı, bulantı ve baş dönmesi şikâyeti ile acil servislere başvururlar.…”

“…4 CO intoksikasyonu herkesin bildiği gibi bulantı, iştahsızlık, halsizlik gibi nonspesifik şikayetlerle başlar. 5 Uzun süre maruziyet sonrası ise şuur değişikliği hatta kardiyopulmoner arrest bile gelişebilir. Bu makalede 21 ve 20 yaşlarında nargile içimi sonrasında CO intoksikasyonuna bağlı bayılma ile gelen iki vaka sunulmuştur.…”

A review of the health effects of smoking shisha

“…Typically, carboxyhaemoglobin concentrations are greater than 10% in shisha smokers, compared with 6.5% in cigarette smokers and 1.6% in nonsmokers. 13 One recent study also noted that acute levels of CO increased signifi cantly, possibly contributing to CO poisoning. 3 In these cases, carboxyhemoglobin levels can reach between 20-30% and patients may present with a loss of consciousness, headaches and shortness of breath.…”

“…3 In these cases, carboxyhemoglobin levels can reach between 20-30% and patients may present with a loss of consciousness, headaches and shortness of breath. 13 Nicotine levels increase signifi cantly from 2 to 6 ng/ml after smoking shisha for fi ve minutes. Increasing nicotine levels have been shown to induce increases in heart rate and may contribute to various cardiovascular diseases.…”

Inhaling smoke causes smoke inhalation: put that in your hookah pipeǃ

“…In this issue, La Fauci and colleagues warn us about an unusual cause of carbon monoxide poisoning: smoking a narghile, commonly known as a water pipe or hookah. 1 Case reports are valuable not just for cautioning us, as so many do, to ''be aware'' but also when they identify the leading edge of something big. And hookah smoking is becoming increasingly popular in Canada, with a self-reported past-year prevalence of about one-quarter of young adults in a recent survey.…”