Accelerated heartbeat/breathing episode underwater w/tingling above water:Dehydratio?

[RyanDelMundo]

I had a health incident diving yesterday.

I was diving Nitrox/33 and was well within my limits, 24 hrs since my previous dives. Max depth 17m, and not there very long. I've been averaging nearly 2 dives a day for the past say 7-8 days.

At around 9m I all of a sudden experienced a very fast heartbeat and began breathing fast, causing me to get very worried. I tried to relax and after 30 seconds or so, this went away.

I felt fine the rest of the dive, and as we swam around at 4-6m for awhile, I had at least a 4-5 minute safety stop.

Upon surfacing I felt OK, ate a small meal of tasty thai curry (I'm in Thailand), and then began feeling weak, my heartbeat increased, and had a severe tingling feeling in my hands and up to my elbows, most pronounced in my left arm.

I immediately went on Oxygen. I breathed O2 for about 2.5 hrs and drank a lot of water. For the first 2 hrs I felt very weak, with a pulse of 100bpm and the tingling was prominent in one of my arms. Big thanks to my fellow DM's and instructors on the boat for excellent first aid! Keeping up to snuff on EFR and Rescue Diving training pays off.

After say 2 hours on the boat, I began to feel better.

I walked to what goes for a hospital here and still had increased heartrate (90) and high blood pressure (180 vs 120). Treated for dehydration with 3000ml saline. Walking out of the hospital I felt just about 100%, but obviously a bit worn out from the experience

Everyone seems to agree this is a case of dehydration. As my symptoms disappeared so quickly, and I was well within the limits of my computer, I don't fear DCS.

But I'm quite worried about what happened - and in order to be a safe diver going forward I want to best understand it.

The part I don't understand is the 30-second incident of raised heartbeat underwater. Is this a symptom of dehydration? Why did it come and go?

I read a little bit about CO2 retention. I have a tendency to breath deeply and slowly. Would this be a cause?

Are there other hypothesis for what happened? Or does this sound like a classic case of dehydration? If there is cause for alarm, I can get a more thorough checkup when I hit the mainland.

I'm an experienced divemaster, always taking care to ascend slowly and obey the usual recommendations, and this dive was slow and easy and no exception. I'd had beers the previous evening but wasn't hungover or anything the next day.

Happy to provide more details.

Cheers!

Ryan in Thailand

 

[Duke Dive Medicine]

Hi Ryan,
A systolic blood pressure of 180 does not sound like dehydration to me. A few questions for you:

Did they draw any labs in the hospital, and if so, can you share the results?
Did they perform an EKG, and if so, what did it show?
How old are you, and are you under a doctor's care for anything else?
When you experienced the rapid heart beat under water, did it feel like your heart suddenly accelerated? Did your heart feel "fluttery"

Your symptoms are a little concerning. It sounds like you're on a dream dive vacation, but if I was there, I'd be advising you to stay out of the water until you've had a further workup.

 

[DocVikingo]

Hi Ryan,

Reflex tachycardia, increased respiratory rate and paraesthesias in the upper extremities indeed can be manifestations of pronounced dehydration. However, it is somewhat unlikely that in dehydration severe enough to precipitate these they would be the only signs/symptoms other than a feeling of weakness. And, a systolic BP as high that you report is not a typical sign of dehydration.

One might also expect some combination of dry mouth, thirst, loss of appetite, dry skin, flushing of the skin, decreased urine output, darkening of the urine, chills, dizziness, dimming of vision, momentary disorientation upon standing up quickly, or worse.

It is suggestive that drinking lots of water and hospital-based IV rehydration appeared to have almost completely ameliorated the complaints, but spontaneous resolution of a condition unrelated to, or only weakly related to, dehydration cannot be conclusively ruled out.

You make no mention of panic, but do you have any history of panic episodes or did you experience any features of panic during the dive in question? Are you otherwise in a good state health and fitness?

Some of what you report can be seen in C02 retention, but in the absence of significant headache, possibly with accompanying nausea and confusion, this seems an unlikely cause.

Should these signs/symptoms recur, either u/w/ or topside, a trip to your physician would be indicated.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual and should not be construed as such.

 

[TSandM]

It takes a volume loss of 15 to 30% of total blood volume to produce tachycardia. This degree of dehydration is seen in patients with acute blood loss, or marked fluid losses like severe diarrhea, or in people who are unable to reach fluids (like debilitated elderly). Patients with normal mental status and no severe illness will be extremely thirsty. And the tachycardia develops slowly, the pulse rising as the volume depletion increases.

A sudden episode of rapid heart rate is much more concerning for an electrical issue with the heart. However, a pulse of 100 on the boat is not really suggestive of an arrhythmia. And the tingling in the arms is neither consistent with arrhythmia nor with dehydration, but would make me think more of either DCS or hyperventilation.

Duke Dive Medicine asked some very good questions, but I would add a couple -- how old are you, and do you have any other health problems (eg. diabetes) that could give you similar symptoms?

 

[Duke Dive Medicine]

duke dive medicine asked some very good questions, but i would add a couple -- how old are you, and do you have any other health problems (eg. Diabetes) that could give you similar symptoms?

how old are you, and are you under a doctor's care for anything else?

gmta :d

 

[DocVikingo]

And the tingling in the arms is neither consistent with arrhythmia nor with dehydration, but would make me think more of either DCS or hyperventilation.

Hi TSandM,

Are you quite certain that tingling of the extremities, incuding the arm and hand, is never seen in dehydration?

Thanks,

Doc

 

[DocVikingo]

Hi Ryan, Are you otherwise in a good state health and fitness?

gmta

Regards,

Doc

 

[TSandM]

Tingling is certainly seen in electrolyte imbalances, but with simple volume depletion, I would say no. And as an ER doc, I treat a lot of various sorts of volume loss . . .

 

[RyanDelMundo]

Hey everyone,

Thanks for the great replies!

I'm 36 with no health problems that I know of. I'm not on a dream vacation, I am working as a Divemaster, so I'm in fairly decent shape as I'm lugging tanks around, assisting with first-time Discovery Scuba divers and OW students, and doing the odd fun dive. This happened on a fun dive, and certainly not a strenuous one.

The hospital did not do any blood work. They did check my pulse by putting some sort of thing over my finger, not sure if that is how an EKG is done these days.

I haven't had any instances of panic underwater either.

As for the CO2, no, I didn't have a headache, so doesn't sound like that either.

Since you have expressed some concern, I'll pop into the proper hospital in Phuket in a few days (I'm on my way there anyway). They have a diving specialist doctor that can give me a check-up.

Does anyone recommend some testing I should have performed?

 

[Rick Murchison]

Hmmm... hmmm... I'm not a doctor, nor do I play one on TV.
However, I have been to Thailand.
How much Singha did you consume the night before the incident?
Did you take any decongestant?
Just a couple of possible "contributors" that popped to mind.

Rick