Prehospital and Disaster Medicine

Case Report

Multiple Patients with Carbon Monoxide Toxicity from Water-Pipe Smoking

Simon F.J. Clarkea1a2 c1, Caroline Stephensa3, Maisse Farhana3, Patricia Warda3, Catherine Keshishiana2, Virginia Murraya2 and Dominik Zennera4

a1 Emergency Department, Frimley Park NHS Foundation Trust, Camberley, Surrey, United Kingdom

a2 Centre for Radiation, Chemical and Environmental Hazards, London, Health Protection Agency, United Kingdom

a3 Emergency Department, St Mary's Hospital, London, United Kingdom

a4 Health Protection Services, Colindale, London, Health Protection Agency, United Kingdom


This case report describes carbon monoxide toxicity from prolonged shisha (water-pipe) smoking. The evidence base for the source and pathway of toxicity is discussed. This practice has been increasing in the UK in recent years, and emergency physicians need to be aware of the high levels of CO, with the consequent risk of clinical poisoning from water-pipe smoking.

SFJ Clarke, C Stephens, M Farhan, P Ward, C Keshishian, V Murray, D Zenner. Multiple patients with carbon monoxide toxicity from water-pipe smoking. Prehosp Disaster Med. 2012;27(6):1-3.

(Received March 10 2011)

(Accepted March 13 2012)

(Revised April 17 2012)

(Online publication September 19 2012)


  • carbon monoxide poisoning;
  • carboxyhemoglobin;
  • emergency medical services;
  • smoking;
  • water-pipe smoking


c1 Correspondence: Simon Clarke, DA, FRCS, FCEM Emergency Department, Frimley Park NHS Foundation Trust Portsmouth Road, Frimley, Camberley, Surrey, GU16 7UJ United Kingdom E-mail