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. Carbon monoxide (CO) poisoning is one of the leading causes of death in both adults and children worldwide. CO intoxication can be notoriously nonspecific in its initial presentation to the emergency department (ED), leading to a delay in diagnosis and treatment. Typical peak carboxyhemoglobin (CO-Hb) concentrations in narghile smokers are greater (10.1%) than in cigarette smokers (6.5%) or nonsmokers (1.6%), and a single narghile smoking session results in substantially more smoke and CO exposure compared to cigarette smoking, despite similar plasma nicotine concentrations. A linear relationship exists between smoking intensity and CO concentration.