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Silent Killer: A Case Report on Carbon Monoxide Poisoning
Nicole Lipman1, Stephanie Widmer1
1Department of Emergency Medicine, St. John's Riverside Hospital, Yonkers, New York.
The Journal of Emergency Medicine
|November 13, 2025
Summary
Hookah smoking can cause carbon monoxide (CO) poisoning, even without tobacco. Emergency physicians must recognize this risk, as symptoms are nonspecific and pulse oximetry is unreliable for diagnosis.
Area of Science:
- Toxicology
- Emergency Medicine
- Environmental Health
Background:
- Carbon monoxide (CO) poisoning is a serious health risk from combustion sources.
- Hookah (waterpipe) smoking is an under-recognized cause of CO poisoning due to burning charcoal.
- Nonspecific symptoms of CO poisoning can delay diagnosis in the emergency department (ED).
Purpose of the Study:
- To highlight the risk of CO poisoning from hookah smoking.
- To emphasize the importance of considering hookah use in CO poisoning cases.
- To inform emergency physicians about the diagnostic challenges and management of hookah-related CO poisoning.
Main Methods:
- Case report of a 37-year-old male found unresponsive after hookah smoking.
- Analysis of venous blood gas showing elevated carboxyhemoglobin (CO) level (24.9%).
- Treatment with hyperbaric oxygen therapy and intensive care unit (ICU) admission.
Main Results:
- The patient's CO level normalized, and mental status improved after treatment.
- Pulse oximetry is unreliable for detecting CO toxicity.
- Carboxyhemoglobin measurement is essential for accurate diagnosis.
Conclusions:
- Hookah-related CO poisoning is often overlooked due to broad symptoms.
- Emergency physicians need a high index of suspicion for hookah-associated CO poisoning.
- Early recognition and oxygen therapy are crucial to prevent severe complications, including delayed neuropsychiatric effects.
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