title: Severe capillary leak syndrome after inner ear decompression sickness in a recreational scuba diver.
abstract: BACKGROUND
  Post-decompression shock with plasma volume deficit is a very rare event that has been observed under extreme conditions of hypobaric and hyperbaric exposure in aviators and professional divers.
  
  
  METHODS
  We report a case of severe hypovolemic shock due to extravasation of plasma in a recreational scuba diver presenting with inner ear decompression sickness. Impaired endothelial function can lead to capillary leak with hemoconcentration and hypotension in severe cases. This report suggests that decompression-induced circulating bubbles may have triggered the endothelial damage, activating the classic inflammatory pathway of increased vascular permeability.
  
  
  CONCLUSIONS
  This observation highlights the need for an accurate diagnosis of this potentially life-threatening condition at the initial presentation in the Emergency Department after a diving-related injury. An elevated hematocrit in a diver should raise the suspicion for the potential development of capillary leak syndrome requiring specific treatment using albumin infusion as primary fluid replacement.
authors.affiliation: Department of Diving and Hyperbaric Medicine, Ste. Anne's Military Hospital, Toulon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gempp
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lacroix
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Cournac
authors.forename: Pierre
authors.initials: P
authors.lastname: Louge
mesh_terms: D019559:Capillary Leak Syndrome / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D002199:Capillary Permeability; D003665:Decompression Sickness / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D004242:Diving / Q000009:adverse effects; D006801:Humans; D006931:Hyperbaric Oxygenation; D034141:Hypoalbuminemia / Q000188:drug therapy / Q000209:etiology; D007759:Labyrinth Diseases / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D063087:Noninvasive Ventilation; D010949:Plasma / Q000378:metabolism*; D012769:Shock / Q000209:etiology* / Q000503:physiopathology