Background: Smoking from a water pipe has become increasingly popular, but this is not as innocent as it seems.
Case description: Three women presented to the emergency department after having smoked from a water pipe. The first patient had experienced a syncopal episode and still had symptoms of dizziness and a headache afterwards. The second patient only had a headache and the third had no symptoms. The physical examinations and standard vital sign measurements of all three patients were normal. Analyses of the arterial blood gases, however, showed carbon monoxide (CO) poisoning: the patients had HbCO concentrations of 22, 19.5 and 5.7%, respectively. We administered high concentrations of oxygen to each, but the first 2 patients continued to experience symptoms for several weeks. The CO poisoning was probably caused by the incomplete combustion of the charcoal in the water pipe which resulted in CO being released.
Conclusion: The regular or even one-time use of a water pipe containing tobacco or an aromatised substance can cause CO poisoning. Patients can continue to experience symptoms for weeks after an episode of acute CO poisoning.