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a new study has proven that smoking tobacco in water pipe can cause carbon monoxide poisoning even after a brief usewhen smoking outdoors or by passive indoor exposureespecially in youths.
smoking tobacco in water pipe (also known as shisha, hookah or hookah) is a method in which tobacco is heated with coal and the resulting smoke passes through the water before being inhaled. Although this practice originated in Middle East at the end of the Middle Agescarries a significant risk of carbon monoxide exposuresince the coal used to heat it produces CO due to a incomplete combustion.
Within the jurisdiction of Tokyo Third Fire District (Japan) emergency services recorded approximately one case of acute CO poisoning related to the consumption of hookah per month between January 2018 and June 2023. The Most of these cases affected young people.
In the present studythe research team carried out a systematic review of six academic databases to identify case reports and case series that described carbon monoxide poisoning associated with hookah consumption all over the world.
68 cases identified, many in closed spaces
According to Europa Press, the review identified a total of 68 cases of acute carbon monoxide (CO) poisoning. Of these, 41 cases corresponded to active users, 23 to grouped incidents that affected several people (up to 12 people simultaneously in closed spaces), and two cases in people who did not consume CO and two cafeteria employees where water pipe was smoked.
He The most common symptom was syncope (53%)followed by headache (50%)he lethargy (44%)the nausea or vomiting (38%) and the weakness (15%). The acute CO poisoning can present various clinical manifestations, and among the additional symptoms reported were included tremors, visual disturbances and seizures.
Approximately a quarter of cases developed symptoms after people They had already left the place where they smoked. Besides, about a fifth of cases occurred after less than an hour of use of the water pipe, and another fifth occurred during outdoor consumptionwhich indicates that even short-term or outdoor use does not eliminate the risk of carbon monoxide poisoning.
The review also identified 13 cases of polycythemiaa condition chronic characterized by persistently elevated hemoglobin levels and a increase in red blood cell count. This condition is a consequence of prolonged exposure to carbon monoxidewhich causes chronic hypoxia and stimulates compensatory erythrocytosis. Twelve of these cases corresponded to people who reported consuming a hookah daily..
Risks even in “low risk” conditions
In general, this systematic review demonstrates that the carbon monoxide poisoning associated with hookah consumption can occur in conditions that are usually considered low risklike the use for short periods, smoking outdoors wave passive exposure in indoor environments.
These findings underscore the importance of raise awareness among hookah users and service providers about the possible risks. In particular, when using hookahs indoorsis It is essential to adopt appropriate security measureslike the installation of carbon monoxide detectors and the implementation of appropriate ventilation systemssince the group poisoning cases They are usually associated with closed environments.
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