Carbon monoxide from hookah smoking: an unusual source of poisoning

ESSEX COUNTY, NJ — Do not smoke hookah pipes in small and/or poorly ventilated spaces, such as basements, sheds, dorm rooms, vehicles, attics, boat cabins, etc., cautions a recent press release from the NJ Poison Control Center through the NJ Division of Fire Safety.

According to the release, in one case, a young adult male passed out after smoking hookah in a small, poorly ventilated room. The patient was transported to the emergency room and was diagnosed with severe carbon monoxide poisoning. He received oxygen and was transferred to a hyperbaric oxygen chamber for further medical care. The long-term neurologic effects are not yet known.

While most people think of gas appliances, heating systems, portable gas generators, charcoal or gas grills, and chimney flues as potential sources of carbon monoxide, smoking hookah is quickly gaining recognition among the health care community as a potential source. There are approximately 100 cases reported in the medical literature discussing the risk for CO poisoning to hookah smokers and those around them. The risk of carbon monoxide poisoning depends on the size of the space you are smoking in, the number of people smoking in that space and how well ventilated the space is.

“As we see every heating season, carbon monoxide can and does kill,” said Dr. Diane Calello, executive and medical director of the NJ Poison Control Center.

Carbon monoxide is known as the “silent killer” for a reason. It is a gas that gives no warning — you cannot see it, smell it or taste it.

“While the risk of CO poisoning from hookah smoke is recognized among health care providers, the risk seems less familiar to hookah smokers themselves,” Calello, who practices emergency medicine at the Rutgers NJ Medical School, said.

Hookah pipes, also known as waterpipes, use charcoal in the process of producing vapor. Unfortunately, charcoal also produces carbon monoxide gas. This potentially deadly gas is inhaled along with the tobacco smoke, possibly leading to severe CO poisoning, particularly if ventilation is poor. Symptoms may include headaches, sleepiness, fatigue, confusion and irritability at low levels. At higher levels, it can result in nausea, vomiting, irregular heartbeat, impaired vision and coordination, brain damage, and death. Unfortunately, symptoms of carbon monoxide poisoning can easily be confused with symptoms of viral illnesses like the common cold or seasonal flu.

“Prevention and early detection are crucial in preventing injury and even death from carbon monoxide,” Calello said. “The well-being of hookah smokers and those around them depend on it.”

Any tobacco use, particularly any use associated with an additional risk of carbon monoxide poisoning, is not recommended. Individuals who nevertheless choose to use hookah pipes should only do so in well-ventilated areas. Have battery-operated carbon monoxide detectors on every level of the building and near every sleeping area. Replace your CO detector every five to seven years because the sensors can degrade. Remember to check the batteries of both fire and CO detectors when changing the clocks twice a year for daylight saving time.

CO poisoning is serious and should be handled as a medical emergency. Get help immediately if you suspect someone was exposed to carbon monoxide. Call the NJ Poison Control Center unless the person is unconscious, not breathing, hard to wake up or seizing, then call 9-1-1. Poison control centers are a great resource for information and emergencies, so keep them at your fingertips. Save the Poison Help number, 1-800-222-1222, as a contact in your cell phone.