There’s no smoke without a fire

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S.L. Gerritse, Y. Tan

Voorzitter(s): prof. dr. M.M.H. Kramer, VUmc, Amsterdam & dr. C.G. Vermeij, Deventer Ziekenhuis

Woensdag 22 april 2015

15:00 - 16:00u in Zaal 0.5

Categorieën: parallelsessie (case reports/research)

Parallel sessie: Parallelsessie 4: Case reports/research

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Case:
A 23 year old male, with an unremarkable medical history, presented to the Emergency department with a blurred vision, near syncope, headache, nausea and chest pain. He stated that he had taken neither medication nor drugs. Physical and neurological examination showed no abnormalities. Laboratory tests were unremarkable. ECG showed no acute ischemia. His social history revealed working in a shisha lounge (an establishment where people share flavored tobacco by water pipe or hookah). He had to light up the water-pipes by inhaling through the hose. He lighted up 20-30 water-pipes on an average work day. He complained having a headache almost every day after work, in the absence of the other present symptoms. Arterial blood gas analysis showed an FCOHb level of 23,2%. The patient was administered high-dose oxygen (15 L/min) via a non-rebreather mask. After four hours the patient’s FCOHb level was decreased to 2,1% and he was discharged from the hospital with no further manifestations.

Conclusion:
Smoking the hookah is becoming increasingly popular among young adults. Due to the process of charcoal combustion a hookah smoker inhales 10 times more carbon monoxide than a cigarette smoker. Due to its nonspecific symptoms carbon monoxide intoxication is probably more common than generally realized. Emergency admission staff should asked specifically about water-pipe exposure in patients presenting with nonspecific (neurologic) symptoms, followed by carboxyhemoglobin measurement.