We wish to report the case of one of our own patients, in whom hookah smoking had resulted in a carboxyhemoglobin concentration of 18% (detected by pulse oximetry) and consecutive syncope. Interestingly, the rescue team’s carbon monoxide alarms went off as soon as they entered the apartment. The fire brigade, which was alerted subsequently, measured a maximum indoor carbon monoxide concentration of 85 ppm in the apartment. Further operations found occasional indoor carbon monoxide concentrations of up to 200 ppm after hookah consumption.
We conclude from these observations that even just dwelling in indoor locations where hookahs are smoked—which is a common occurrence in so called shisha bars—may be sufficient to induce toxicologically relevant carbon monoxide exposure.
Barnett et al. described—in a series of 193 persons who regularly visited shisha bars—significantly higher carbon monoxide concentrations than in a control group (1). A selective literature search did not identify any publications focusing on the subject of carbon monoxide concentrations in such places.
In our view, further systematic studies are urgently required, especially of indoor carbon monoxide concentrations in commercially run shisha bars, because the risk potential in this setting can currently only be speculated on.
Dr. med. Robert Stangl
Dr. med. Cornelius Voigt
Berufsfeuerwehr Köln, Institut für Notfallmedizin
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