[SIZE=+3]Saltwater Aspiration Syndrome[/SIZE]
[SIZE=+1]You've just gotten home from a dive and you're feeling rotten. You ache all over, are so tired you can hardly hold your head up and you have a low grade fever, nausea, headache or shivering. You might even have some shortness of breath and a productive cough. You wonder if you might not have decompression symptoms. [/SIZE]
[SIZE=+1]Well, it might not be bronchitis or pneumonia from some creepie-crawlies in your regulator, but most likely salt water in your lungs that's to blame. First described by Dr.Carl Edmonds, this flu-like condition and short-term respiratory distress in divers occurs when even small amounts of micronized saltwater mist is inhaled into the lungs. Although not well-recognized, it's called saltwater aspiration syndrome and it can be avoided by taking several actions. [/SIZE]
[SIZE=+1]Treatment[/SIZE]
[SIZE=+1]Interpolation of management would be similar to that given mildly affected cases of near-drowning. Most individuals are not this severely affected and never seek medical care. Others continue with severe cough and bronchospasm and require assistance. Patients with minimal symptoms (eg, coughing) and normal oxygen saturation should be observed for 24 hours; nearly all recover spontaneously within a few hours. In saltwater drownings and saltwater "wet" near-drownings (those that involve aspiration), the hypertonicity of the aspirated fluid draws intravascular fluid into the already fluid-filled alveoli, resulting in ventilation-perfusion abnormalities and intrapulmonary shunting. Intravascular hypovolemia, hemoconcentration, and electrolyte abnormalities can result, although this is not usually seen clinically in near-drowning survivors because they rarely aspirate enough water to produce these effects. It is doubtful that there is enough volume aspirated through a regulator to cause significant electrolyte abnormalities. [/SIZE]
[SIZE=+1]Divers who are alert but in respiratory distress require transfer to an intensive care setting for chest roentgenography, oxygen administration, and monitoring of oxygen saturation, arterial blood gases, urinary output, and electrolytes. [/SIZE]
[SIZE=+1] The initial chest film may be normal despite marked cough or respiratory distress. Since water ingestion and asphyxia can damage the alveolar capillary membrane, pulmonary edema can occur hours later as ARDS (Adult Respiratory Distress Syndrome). Frequent auscultation and continuous monitoring of oxygen saturation can detect this delayed complication. [/SIZE]
[SIZE=+1]Bronchospasm can be treated with inhaled beta agonists (bronchial dilators). In the rare person who proceeds to ARDS. continuous positive airway pressure, with or without mechanical ventilation, may be needed to maintain adequate PO2 and, accompanied by ventilation, is the single most effective treatment for hypoxemia. [/SIZE]
[SIZE=+1]Saltwater is hypertonic and can cause a shift of fluid from the circulation into the lung and pleural space, whereas freshwater is hypotonic to serum and is rapidly absorbed and redistributed. This might account for the productive cough associated with this syndrome and on a chronic basis could cause hemoconcentration, a known risk for decompression accidents. Ingestion of grossly contaminated water can cause pneumonia and lung abscess; fortunately these complications are rare. [/SIZE]
