Diver with decompression injury, elevation of serum transaminase levels, and rhabdomyolysis.
A 43-year-old female recreational scuba diver presented to the emergency department 1 hour after a rapid, uncontrolled ascent. Her presentation included progressing confusion, slow and slurred speech, and complaints of headache and hypesthesia over her forearms and anterior thighs bilaterally. Differential diagnosis included arterial gas embolism and decompression sickness. She underwent recompression therapy with US Navy Table 6 within 120 minutes of her ascent. After recompression therapy, the patient had signs and symptoms consistent with severe rhabdomyolysis, including creatine kinase levels of 36,000 U/L and myoglobinuria.
Shank
E S
ES
Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, MA 02114, USA. eshank@etherdome.mgh.harvard.edu
Muth
C M
CM
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood*; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood*; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D003665:Decompression Sickness / Q000175:diagnosis / Q000201:enzymology* / Q000209:etiology* / Q000628:therapy; D003937:Diagnosis, Differential; D004242:Diving / Q000009:adverse effects*; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D009212:Myoglobinuria / Q000209:etiology / Q000652:urine; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000201:enzymology* / Q000209:etiology* / Q000628:therapy; D013997:Time Factors
D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase; D000469:Alkaline Phosphatase