Carbon Monoxide Poisoning Due to Water Pipe Smoking: Case Series

Introduction: Carbon monoxide poisoning may occur in several contexts.Material and Methods: Retrospective of 37 carbon monoxide poisoning cases that underwent hyperbaric oxygen during wildfires in Funchal in August 2016.Results: The studied sample included 37 patients, mean age of 38 years, 78% males. Ten were firefighters, four children and two pregnant victims. Neurological symptoms were the most reported. Median carboxyhemoglobin level was 3.7% (IQR 2.7). All received high-flow oxygen from admission to delivery of hyperbaric oxygen. Persistence of symptoms was the main indication for hyperbaric oxygen. Median time to hyperbaric oxygen was 4.8 hours (IQR 9.5), at 2.5 ATA for 90 minutes, without major complications. Discharge in less than 24 hours occurred in 92% of the cases. Thirty days follow-up: five patients presented clinical symptoms of late neurological syndrome; twelve patients were lost to follow-up. Carboxyhemoglobin levels on admission and mean time to hyperbaric oxygen were no different between those who did and did not develop the syndrome at 30 days (p = 0.44 and p = 0.58, respectively).Discussion: Late neurological syndrome at 30 days occurred in 20% and no new cases were reported at 12 months.Conclusion: Use of hyperbaric oxygen appears to have reduced the incidence of the syndrome. This seems to be the first Portuguese series reporting use of hyperbaric oxygen in carbon monoxide poisoning due to wildfires. The authors intend to alert to the importance of referral of these patients because the indications and benefits of this treatment are well documented. This is especially important given the ever-growing issue of wildfires in Portugal.

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Effects of donepezil on cognition and global functioning in patients with delayed encephalopathy after carbon monoxide poisoning: A case series

Psychiatry and Clinical Neurosciences ◽

10.1111/pcn.12841 ◽

2019 ◽

Vol 73 (6) ◽

pp. 348-348 ◽

Cited By ~ 1

Author(s):

Wei‐Ting Tseng ◽

Jia‐Yin Yeh ◽

Hsien‐Yuan Lane ◽

Chieh‐Hsin Lin

Keyword(s):

Carbon Monoxide ◽

Carbon Monoxide Poisoning ◽

Case Series ◽

Global Functioning ◽

Delayed Encephalopathy

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COVID-19 morbidity and mortality caused by endogenous carbon monoxide poisoning, with recommendations for testing and treatment

10.31219/osf.io/uvj42 ◽

2020 ◽

Author(s):

Albert Hamburger Donnay

Keyword(s):

Carbon Monoxide ◽

Oxygen Saturation ◽

Carbon Monoxide Poisoning ◽

Cardiac Injury ◽

Case Series ◽

Body Burden ◽

Morbidity And Mortality ◽

Heme Oxygenase 1 ◽

Co Poisoning ◽

Blood Tests

To test our hypothesis that abnormal levels of endogenous carbon monoxide (CO) produced naturally by heme oxygenase-1 (HO-1) in response to infections of all kinds may be contributing to the morbidity and mortality associated with COVID-19, we searched PubMed for peer-reviewed literature on carbon monoxide and each of eleven abnormal blood tests, fourteen signs and symptoms, and five fatal complications of COVID-19 infection reported in a case series from a hospital in Wuhan, China: acute respiratory distress syndrome (ARDS), acute kidney injury, acute cardiac injury, arrhythmia, and shock. We found reports of acute exogenous CO poisoning causing all the same signs, symptoms and complications, and all the abnormal blood tests except D-dimer and procalcitonin. Our search also found endogenous HO-1 and CO levels correlated with these complications, independent of any inhaled CO exposure. In sharp contrast to the CO poisoning literature, most studies of endogenous CO interpret its close positive correlation with these acute conditions as protective, with some going so far as to recommend treating ARDS with inhaled CO. We conclude with new recommendations for testing endogenous CO poisoning in COVID-19 cases using devices approved by the US Food and Drug Administration that can distinguish CO coming from the lungs, arteries, veins, and average of all tissues, unlike current protocols for CO poisoning that only measure CO in arteries or veins but not both. Based on these findings, we appeal to clinicians to start testing CO levels in COVID-19 patients and to stop monitoring oxygen saturation with conventional pulse oximeters that overestimate oxygen saturation by the sum of carboxyhemoglobin and methemoglobin. We conclude by reviewing FDA-approved treatments that may help COVID-19 patients with endogenous CO poisoning. These include zinc-based drugs that lower the rate of endogenous CO production by inhibiting HO-1, and drug-free devices and methods that reduce the total body burden of CO after exogenous CO poisoning.

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Carbon monoxide poisoning in narghile (water pipe) tobacco smokers

CJEM ◽

10.2310/8000.2011.110431 ◽

2012 ◽

Vol 14 (01) ◽

pp. 57-59 ◽

Cited By ~ 38

Author(s):

Giovanna La Fauci ◽

Giora Weiser ◽

Ivan P. Steiner ◽

Itai Shavit

Keyword(s):

Carbon Monoxide ◽

Traditional Method ◽

Literature Search ◽

Carbon Monoxide Poisoning ◽

Young Patients ◽

Adolescent Patient ◽

Co Poisoning ◽

Water Pipe ◽

Oxygen Supplementation ◽

Pipe Tobacco

ABSTRACT Narghile (water pipe, hookah, shisha, goza, hubble bubble, argeela) is a traditional method of tobacco use. In recent years, its use has increased worldwide, especially among young people. Narghile smoking, compared to cigarette smoking, can result in more smoke exposure and greater levels of carbon monoxide (CO). We present an acutely confused adolescent patient who had CO poisoning after narghile tobacco smoking. She presented with syncope and a carboxyhemoglobin level of 24% and was treated with hyperbaric oxygen. Five additional cases of CO poisoning after narghile smoking were identified during a literature search, with carboxyhemoglobin levels of 20 to 30%. Each patient was treated with oxygen supplementation and did well clinically. In light of the increasing popularity of narghile smoking, young patients presenting with unexplained confusion or nonspecific neurologic symptoms should be asked specifically about this exposure, followed by carboxyhemoglobin measurement.

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