Decompression illness with hypovolemic shock and neurological failure symptoms after two risky dives: a case report.
Hypovolemia is known to be a predisposing factor of decompression illness (DCI) while diving. The typical clinically impressive neurological symptoms of DCI may distract from other symptoms such as an incipient hypovolemic shock. We report the case of a 61-year-old male Caucasian, who presented with an increasing central and peripheral neural failure syndrome and massive hypovolemia after two risky dives. Computed tomography (CT) scans of the chest and Magnetic resonance imaging scans of the head revealed multiple cerebral and pulmonary thromboembolisms. Transesophageal echocardiography showed a patent foramen ovale (PFO). Furthermore, the patient displayed hypotension as well as prerenal acute kidney injury with elevated levels of creatinine and reduced renal clearance, indicating a hypovolemic shock. Early hyperbaric oxygen (HBO) therapy reduced the neurological deficits. After volume expansion of 11 liters of electrolyte solution (1000 mL/h) the cardiopulmonary and renal function normalized. Hypovolemia increases the risk of DCI during diving and that of hypovolemic shock. Early HBO therapy and fluid replacement is crucial for a favorable outcome.
Section for Maritime Medicine, Institute of Experimental Medicine Christian-Albrechts-University Kiel c/o German Naval Medical Institute, Kopperpahler Allee 120, Kronshagen, 24119, Germany s.klapa@iem.uni-kiel.de.
Sebastian
http://orcid.org/0000-0002-0012-0163
S
Klapa
Department of Neurology, UKSH Campus Kiel, Schittenhelmstraße 10, Kiel, 24105, Germany.
Johannes
J
Meyne
Section for Maritime Medicine, Institute of Experimental Medicine Christian-Albrechts-University Kiel c/o German Naval Medical Institute, Kopperpahler Allee 120, Kronshagen, 24119, Germany.
Wataru
W
Kähler
Section for Maritime Medicine, Institute of Experimental Medicine Christian-Albrechts-University Kiel c/o German Naval Medical Institute, Kopperpahler Allee 120, Kronshagen, 24119, Germany.
Frauke
F
Tillmans
Section for Maritime Medicine, Institute of Experimental Medicine Christian-Albrechts-University Kiel c/o German Naval Medical Institute, Kopperpahler Allee 120, Kronshagen, 24119, Germany.
Henning
H
Werr
Department of Neurology, UKSH Campus Kiel, Schittenhelmstraße 10, Kiel, 24105, Germany.
Andreas
A
Binder
Section for Maritime Medicine, Institute of Experimental Medicine Christian-Albrechts-University Kiel c/o German Naval Medical Institute, Kopperpahler Allee 120, Kronshagen, 24119, Germany.
Andreas
A
Koch
D058186:Acute Kidney Injury / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D001921:Brain / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000097:blood; D003665:Decompression Sickness / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D004242:Diving / Q000009:adverse effects*; D054092:Foramen Ovale, Patent / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D006931:Hyperbaric Oxygenation; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes; D012769:Shock / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome
D010952:Plasma Substitutes; D003404:Creatinine
Decompression illness; hypovolemic shock syndrome; patent foramen ovale; systemic inflammatory response syndrome