Case Report
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Carbon Monoxide Poisoning Following Use of a Narghile: Presentation of Three Case Reports

Year 2025, Volume: 39 Issue: 2, 256 - 262, 25.08.2025
https://doi.org/10.61970/adlitip.1617114

Abstract

Narghile, also known as a water pipe, shisha, or hookah, is a type of smoking instrument popular in Indian, Middle Eastern, and Mediterranean countries and has become popular in Europe and North America. Narghile smoke contains high concentrations of carbon monoxide (CO), among other toxic substances, and complications due to CO poisoning after narghile use have been reported by various studies. In this study, three cases were admitted to the emergency department due to CO poisoning after narghile use, and their treatment schemes are presented. The consequences of CO poisoning are important in terms of public health and forensic processes. Therefore, we would like to emphasize that clinicians should be careful about the possibility of CO poisoning due to narghile consumption, especially in closed areas such as narghile cafes. In cases of CO poisoning, forensic case notification should be made, and forensic medicine specialists should be consulted.

References

  • 1. WHO study group on tobacco product regulation: Report on the scientific basis of tobacco product regulation: Eighth report of a WHO study group. USA: WHO, 2021.
  • 2. Maziak W, Taleb ZB, Bahelah R, Islam F, Jaber R, Auf R, et al. The global epidemiology of waterpipe smoking. Tob Control. 2015 Mar;24 Suppl 1(Suppl 1):i3-i12.
  • 3. Arziman, I., Acar, Y. A., Yildirim, A. O., Cinar, O., Cevik, E., Eyi, Y. E., Kaldirim, U. Five cases of carbon monoxide poisoning due to narghile (shisha). Hong Kong Journal of Emergency Medicine, Jul 2011, 254-3,
  • 4. Shihadeh A, Saleh R. Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food Chem Toxicol. 2005 May;43(5):655-61.
  • 5. Theron A, Schultz C, Ker JA, Falzone N. Carboxyhaemoglobin levels in water-pipe and cigarette smokers. S Afr Med J. 2010 Jan 29;100(2):122-4.
  • 6. La Fauci G, Weiser G, Steiner IP, Shavit I. Carbon monoxide poisoning in narghile (water pipe) tobacco smokers. Cjem. 2012 Jan;14(1):57-9.
  • 7. Canpolat Ö. Rare side effect of Hookah Smoking; Carbon Monoxide Poisoning. Acta Oncologica Turcica. 2020 2020;53(1):155-7.
  • 8. Baykan N, Durukan P, Salt Ö, Yakar Ş, ÖZkan S. Carbonmonoxide Intoxication After Narghile Smoking: Two Case Presentations. Ankara Medical Journal. 2017 December;17(4):305-7.
  • 9. Lim BL, Lim GH, Seow E. Case of carbon monoxide poisoning after smoking shisha. Int J Emerg Med. 2009 Mar 11;2(2):121-2.
  • 10. Von Rappard J, Schönenberger M, Bärlocher L. Carbon monoxide poisoning following use of a water pipe/hookah. Dtsch Arztebl Int. 2014 Oct 3;111(40):674-9.
  • 11. Wu L, Wang R. Carbon monoxide: endogenous production, physiological functions, and pharmacological applications. Pharmacol Rev. 2005 Dec;57(4):585-630.
  • 12. Weaver, L. K. (2009). Clinical practice. Carbon monoxide poisoning. The New England Journal of Medicine, 360(12), 1217- 1225.
  • 13. Stewart RD. The effect of carbon monoxide on humans. Annu Rev Pharmacol. 1975;15:409-23.
  • 14. Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
  • 15. Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med. 2017 Mar 1;195(5):596-606.
  • 16. Asma S, Gereklioğlu Ç, Korur A, Solmaz S. Waterpipe smoking: an incidios threat for the young. Turkish Journal of Family Medicine and Primary Care. 2016;10(2):91-5.
  • 17. El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associate with waterpipe smoking. Tob Control. 2015 Mar;24 Suppl 1(Suppl 1):i31-i43.
  • 18. Grieb G, Groger A, Bozkurt A, Stoffels I, Piatkowski A, Pallua N. The diversity of carbon monoxide intoxication: medical courses can differ extremely-a case report. Inhal Toxicol. 2008 Aug;20(10):911-5.
  • 19. Yadav JS, Thakur S. Genetic risk assessment in hookah smokers. Cytobios. 2000;101(397):101-13.

Nargile Kullanımına Bağlı Karbonmonoksit Zehirlenmesi: Üç Olgu Sunumu

Year 2025, Volume: 39 Issue: 2, 256 - 262, 25.08.2025
https://doi.org/10.61970/adlitip.1617114

Abstract

Nargile, nargile veya nargile olarak da bilinen nargile, Hindistan, Orta Doğu ve Akdeniz ülkelerinde popüler olan ve Avrupa ve Kuzey Amerika’da popüler hale gelen bir tür sigara içme aracıdır. Nargile dumanı, diğer toksik maddelerin yanı sıra yüksek konsantrasyonlarda karbon monoksit (CO) içerir ve nargile kullanımından sonra CO zehirlenmesine bağlı komplikasyonlar çeşitli çalışmalarda bildirilmiştir. Bu çalışmada, nargile kullanımı sonrası CO zehirlenmesi nedeniyle acil servise başvuran üç olgu ve tedavi şemaları sunulmuştur. CO zehirlenmesinin sonuçları halk sağlığı ve adli süreçler açısından önemlidir. Bu nedenle özellikle nargile kafeler gibi kapalı alanlarda nargile tüketimine bağlı CO zehirlenmesi olasılığı konusunda klinisyenlerin dikkatli olması, CO zehirlenmesi olgularında adli vaka bildiriminin yapılması ve adli tıp uzmanlarına başvurulması gerektiğini vurgulamak isteriz.

References

  • 1. WHO study group on tobacco product regulation: Report on the scientific basis of tobacco product regulation: Eighth report of a WHO study group. USA: WHO, 2021.
  • 2. Maziak W, Taleb ZB, Bahelah R, Islam F, Jaber R, Auf R, et al. The global epidemiology of waterpipe smoking. Tob Control. 2015 Mar;24 Suppl 1(Suppl 1):i3-i12.
  • 3. Arziman, I., Acar, Y. A., Yildirim, A. O., Cinar, O., Cevik, E., Eyi, Y. E., Kaldirim, U. Five cases of carbon monoxide poisoning due to narghile (shisha). Hong Kong Journal of Emergency Medicine, Jul 2011, 254-3,
  • 4. Shihadeh A, Saleh R. Polycyclic aromatic hydrocarbons, carbon monoxide, “tar”, and nicotine in the mainstream smoke aerosol of the narghile water pipe. Food Chem Toxicol. 2005 May;43(5):655-61.
  • 5. Theron A, Schultz C, Ker JA, Falzone N. Carboxyhaemoglobin levels in water-pipe and cigarette smokers. S Afr Med J. 2010 Jan 29;100(2):122-4.
  • 6. La Fauci G, Weiser G, Steiner IP, Shavit I. Carbon monoxide poisoning in narghile (water pipe) tobacco smokers. Cjem. 2012 Jan;14(1):57-9.
  • 7. Canpolat Ö. Rare side effect of Hookah Smoking; Carbon Monoxide Poisoning. Acta Oncologica Turcica. 2020 2020;53(1):155-7.
  • 8. Baykan N, Durukan P, Salt Ö, Yakar Ş, ÖZkan S. Carbonmonoxide Intoxication After Narghile Smoking: Two Case Presentations. Ankara Medical Journal. 2017 December;17(4):305-7.
  • 9. Lim BL, Lim GH, Seow E. Case of carbon monoxide poisoning after smoking shisha. Int J Emerg Med. 2009 Mar 11;2(2):121-2.
  • 10. Von Rappard J, Schönenberger M, Bärlocher L. Carbon monoxide poisoning following use of a water pipe/hookah. Dtsch Arztebl Int. 2014 Oct 3;111(40):674-9.
  • 11. Wu L, Wang R. Carbon monoxide: endogenous production, physiological functions, and pharmacological applications. Pharmacol Rev. 2005 Dec;57(4):585-630.
  • 12. Weaver, L. K. (2009). Clinical practice. Carbon monoxide poisoning. The New England Journal of Medicine, 360(12), 1217- 1225.
  • 13. Stewart RD. The effect of carbon monoxide on humans. Annu Rev Pharmacol. 1975;15:409-23.
  • 14. Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. StatPearls. Treasure Island (FL): StatPearls Publishing Copyright © 2023, StatPearls Publishing LLC.; 2023.
  • 15. Rose JJ, Wang L, Xu Q, McTiernan CF, Shiva S, Tejero J, et al. Carbon Monoxide Poisoning: Pathogenesis, Management, and Future Directions of Therapy. Am J Respir Crit Care Med. 2017 Mar 1;195(5):596-606.
  • 16. Asma S, Gereklioğlu Ç, Korur A, Solmaz S. Waterpipe smoking: an incidios threat for the young. Turkish Journal of Family Medicine and Primary Care. 2016;10(2):91-5.
  • 17. El-Zaatari ZM, Chami HA, Zaatari GS. Health effects associate with waterpipe smoking. Tob Control. 2015 Mar;24 Suppl 1(Suppl 1):i31-i43.
  • 18. Grieb G, Groger A, Bozkurt A, Stoffels I, Piatkowski A, Pallua N. The diversity of carbon monoxide intoxication: medical courses can differ extremely-a case report. Inhal Toxicol. 2008 Aug;20(10):911-5.
  • 19. Yadav JS, Thakur S. Genetic risk assessment in hookah smokers. Cytobios. 2000;101(397):101-13.
There are 19 citations in total.

Details

Primary Language English
Subjects Forensic Medicine
Journal Section Case Report
Authors

Eda Yiğit 0000-0003-2129-1620

Faruk Aşıcıoğlu 0000-0003-1691-6171

Publication Date August 25, 2025
Submission Date January 14, 2025
Acceptance Date August 15, 2025
Published in Issue Year 2025 Volume: 39 Issue: 2

Cite

Vancouver Yiğit E, Aşıcıoğlu F. Carbon Monoxide Poisoning Following Use of a Narghile: Presentation of Three Case Reports. J For Med. 2025;39(2):256-62.
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