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Background: Water pipe (hookah) smoking has become a
common activity in Germany, particularly among adolescents
and young adults; in 2011, its lifetime prevalence
was as high as 68.8%. Similar trends can be seen in other
European countries. Water-pipe smokers are exposed to
the same health-endangering substances as cigarette
smokers, and the inhaled amount of carbon monoxide (CO)
can be as much as ten times as high. In CO intoxication,
carboxyhemoglobin is formed and causes direct injury at
the cellular level, leading to hypoxia and nonspecific
neuro logical manifestations. There have only been ten
reported cases around the world of CO intoxication due to
the use of a water pipe, and none of these were fatal. It
should be recalled, however, that accidental CO intoxica -
tion is common and is associated with high morbidity and
mortality.
Case presentation and course: We present a series of four
young adults, aged 16 to 21, three of whom were hospitalized
because of transient unconsciousness. The carboxy -
hemoglobin (CO-Hb) content of the blood in the symp -
tomatic patients ranged from 20.1% to 29.6%, while the
asymptomatic patient had a CO-Hb content of 16.7%.
Water-pipe smoking was the cause of CO intoxication in all
four cases. The CO-Hb values were successfully brought
down by the administration of highly concentrated oxygen
and all patients were discharged in asymptomatic condition.
Conclusion: This case series reveals that CO intoxication
due to water-pipe smoking is probably more common than
is generally realized. Emergency room staff should be
aware of this problem and inquire specifically about
water-pipe smoking in patients with nonspecific neuro -
logical manifestations.