The following is a summary of “Waterpipe vs non-Waterpipe carbon monoxide poisoning: Comparison of patient characteristics, clinical presentation and outcomes,” published in the May 2024 issue of Emergency Medicine by Abdul-Nabi, et al.

For a study, researchers sought to delineate the disparities between carboxyhemoglobin (CO-Hb) acute poisoning resulting from waterpipe versus non-waterpipe exposures concerning demographics, clinical manifestations, and patient outcomes.

A retrospective cohort study was conducted in Lebanon’s Emergency Department (ED). The study included all adult patients with a CO-Hb level ≥ 10 between January 2019 and August 2023, categorized by exposure type as waterpipe or non-waterpipe.

A total of 111 ED visits were identified, with 73.9% attributed to waterpipe exposure and 26.1% to non-waterpipe sources, including cigarette smoking (17.2%), burning coal (24.1%), fire incidents (3.6%), gas leaks (6.9%), heating device use (10.3%), and undocumented sources (37.9%). Patients with waterpipe-related CO poisoning were younger (41 vs. 50 years, P = 0.015), predominantly women (63.4 vs 41.4%, P = 0.039), and had fewer comorbidities compared to non-waterpipe exposures (22.2 vs 41.4%, P = 0.047). Waterpipe smokers were more likely to present during the summer (42.7 vs 13.8%, P = 0.002) and had shorter ED length of stays (3.9 vs 4.5 h, P = 0.03). Syncope was more prevalent in waterpipe smokers (52.4 vs. 17.2%, P = 0.001), while cough/dyspnea was more common in non-waterpipe exposures (31 vs 9.8%, P = 0.006). Initial CO-Hb levels were significantly higher in waterpipe exposure compared to non-waterpipe (19.7 vs 13.7, P = 0.004). Non-waterpipe exposures were more frequently admitted to the hospital (24.1 vs 4.9%, P = 0.015). Waterpipe smokers had significantly higher odds of experiencing syncope, with a 5.74-fold increase in risk compared to non-waterpipe exposure (P = 0.004), regardless of their CO-Hb level. Additionally, males had significantly lower odds of syncope than females following CO exposure (aOR 0.31, 95% CI 0.13–0.74).

CO poisoning related to waterpipe smoking exhibited distinct characteristics, with syncope being a prominent presentation. A detailed social history should be obtained in communities with prevalent waterpipe smoking. CO poisoning should be considered in patients presenting with headache, syncope, dizziness, vomiting, or shortness of breath, even outside the typical winter season peaks associated with non-waterpipe exposures.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000706