When water does not clear the smut from the smoke

Area of Science:

• Toxicology
• Internal Medicine
• Public Health

Background:

• Water-pipe (shisha) smoking is gaining popularity, particularly among young demographics in Western countries.
• Misconceptions persist that shisha smoking is a safer alternative to cigarette smoking.
• Previous analyses indicate that 1-2 hours of shisha smoking can yield toxicants equivalent to 100-200 cigarettes.

Observation:

• A 25-year-old patient presented with elevated hemoglobin, concentration difficulties, and decreased physical performance.
• Initial molecular tests for JAK2 mutations and BCR-ABL fusion transcripts were negative.
• Arterial blood gas analysis revealed an elevated carboxyhemoglobin level of 6.1%.

Findings:

• The patient admitted to excessive shisha smoking.
• A diagnosis of secondary polycythaemia was established, attributed to chronic carbon monoxide poisoning from shisha use.
• Cessation of shisha smoking led to the normalization of all blood parameters within six weeks.

Implications:

• The rising prevalence of shisha smoking necessitates increased awareness of its potential health risks.
• This case underscores the severe toxicity associated with chronic carbon monoxide exposure from water-pipe use.
• Enhanced tobacco prevention programs should incorporate comprehensive information regarding the dangers of shisha smoking.