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Severe carbon monoxide poisoning from waterpipe smoking: a public health concern

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We believe this is the first Australian report of severe carbon monoxide poisoning caused by waterpipe use. Carbon monoxide poisoning causes neurological dysfunction and myocardial toxicity, effects that can be irreversible. Despite a widespread misconception that waterpipes are safer than cigarettes, the recognised risks of tobacco products also apply to waterpipe use.

Clinical record

A 20-year-old woman was brought by ambulance to the emergency department of a district hospital after an episode of presyncope. She described symptoms of severe light-headedness, mild headache and nausea, but denied experiencing weakness or sensory disturbances. Seizure activity was not reported. She had used a waterpipe for 1 hour before the onset of symptoms. Although this was her first hospital presentation with these symptoms, she had frequently experienced queasiness and light-headedness after using a waterpipe, which she did on most days of the week, each session lasting about 45 to 60 minutes. She denied depression, suicidal ideation, and recent alcohol or drug use.

The patient appeared lethargic. Her vital signs were within normal limits: blood pressure, 115/70 mmHg; pulse rate, 75 beats/min; temperature, 36.7°C; Spo2, 98%; and Glasgow Coma Scale score, 15. Her pupils were dilated (5 mm), equal and reactive to light. Her cranial nerve, upper limb and lower limb…