Had a scare today

[BlueDevil]

The explanation from your pharmacist friend sounds very speculative to me! My drug references make no mention of any need to take Sudafed (pseudoephedrine) with water or food. Nor can I find a listing of adverse effects that match what you experienced. While I couldn't rule out the possibility that Sudafed was involved I don't think you can just make that assumption. As was suggested a medical checkup would be a good idea, the trouble is though that events such as these are often difficult to diagnose and there is often nothing to be found after the event. Often it is more a matter of excluding the serious possibilities, even if the actual cause can't be found.

BD

 

[BlueDevil]

Even though I've been told many times not to take any medication on an empty stomach, I still do.
joe

Keep in mind that some drugs SHOULD be taken on an empty stomach! It depends on the particular drug...some are best taken with food, some are best not taken with food and with some it makes no difference either way. Make sure you check with your doctor, pharmacist, or read the product info, so that you know for sure.

 

[Rick Murchison]

Sudafed is a dangerous drug to me. Causes premature ventricular contractions. My Doc tells me heartbeat irregularities are a common side effect (though my particular reaction is severe and apparently almost unique), and those of us who have 'em should avoid the drug altogether.
Could be that you too are sensitive to it.
"Hyper-reactive individuals may display ephedrine-like reactions such as tachycardia, palpitations, headache, dizziness or nausea. Sympathomimetics have been associated with certain untoward reactions including fear, anxiety, tenseness, restlessness, tremor, weakness, pallor, respiratory difficulty, dysuria, insomnia, hallucinations, convulsions, CNS depression, arrhythmias, and cardiovascular collapse with hypotension."
Personally, I stay away from the stuff.
Rick

 

[diver_paula]

First, it's good to hear you reacted well and are safely only land!

What your friend / pharmacist said and other replies in this thread are quite interesting. I certainly haven't read or been told anything similar wrt Sudafed. You didn't mention which Sudafed you took. The little red one? another?

Paula

 

[Pugsly55]

Sudafed is a dangerous drug to me. Causes premature ventricular contractions. My Doc tells me heartbeat irregularities are a common side effect (though my particular reaction is severe and apparently almost unique), and those of us who have 'em should avoid the drug altogether.
Could be that you too are sensitive to it.
"Hyper-reactive individuals may display ephedrine-like reactions such as tachycardia, palpitations, headache, dizziness or nausea. Sympathomimetics have been associated with certain untoward reactions including fear, anxiety, tenseness, restlessness, tremor, weakness, pallor, respiratory difficulty, dysuria, insomnia, hallucinations, convulsions, CNS depression, arrhythmias, and cardiovascular collapse with hypotension."
Personally, I stay away from the stuff.
Rick

When taken at normal (recommended) doses, for healthy people, sudafed is no more dangerous than a big cup of coffee. That being said, each individual person can react to any substance put into the body differently. I have had patients where plain tylenol made them dead tired and others where muscle relaxers caused insomnia. But statistically, neither is likely.

Stimulants can exacerbate already existing abnormalities. If someone has a partial blockage in a artery or a propensity for heart "palpitations", and a stimulant (sudafed, coffee, whatever, increases heart rate and blood pressure and causes "vasoconstriction" ie. temporary narrowing of blood vessels) and exertion (not to mention breathing compressed gas in an environment colder than body temperature with the weight who knows how much water on you), and you set up an environment perfect for trouble. I am not saying that is what happened without any med history at all but this story, but I sincerly hope you get a further work up before diving in the immediate future.

Good luck and I hope it is just some freak occurrence. The explanation your pharmacist friend gave you is plausible, but I wouldn't bet my life on that being the cause. Best of luck.

 

[Padipro]

You didn't mention what type of gas you were breathing but from the type of diving you were doing, cave diving, I would guess it was some sort of oxygen enriched mix. I was of the belief that Sudafed wasn't to be taken when breathing oxygen enriched gas mixes as could predispose you to oxygen toxicity. Some of the symptoms you discribed sound as though that may be a possibility.

I found this info in the net...

Muscle twitching and spasm
nausea and vomiting
dizziness
vision (tunnel vision) and hearing difficulties (tinnitus)
twitching of facial muscles
irritability, confusion and a sense of impending doom
trouble breathing, anxiety
unusual fatigue
incoordination
convulsion.

Factors increasing risk of O2 toxicity

Increasing exposure time
Increasing depth
Increasing the percentage of inspired O2 (As in nitrox mixtures)
The simple act of immersion setting off the diving reflex
Exercise increasing the metabolic rate
Increased CO2 in the tissues (May be due to cerebral vasodilation)
Cold stress (Shivering is a form of exercise)Systemic diseases that increase the metabolic rate (such as thyroid diseases)
Sympathomimetic drugs (Drugs that mimic adrenalin in effect).

Sudafed is a medication often used by divers due to it's decongestive effect. It has few side effects but is a sympathomimetic drug (pseudephedrine). Whether or not it should be used in nitrox or rebreather diving is discussed by Dr. E.D. Thalmann in DAN's publication at http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=51

"In 1962, none other than DAN's Chief Executive Officer, Dr. Peter Bennett, while working as a research physiologist at the Royal Navy Physiological Laboratory in England, published a paper (Life Sciences; 12:721-727, 1962) testing the hypothesis that oxygen toxicity and nitrogen narcosis were caused by similar mechanisms.

He found that in rats, sympathomimetics seemed to enhance oxygen toxicity. Pseudoephedrine was not tested specifically, but it is a sympathomimetic, so we might infer that it has a similar effect. In addition, our current understanding of the mechanisms which produce oxygen convulsions would predict that sympathomimetic drugs might enhance susceptibility to oxygen convulsions. It has been shown that drugs which inhibit sympathetic stimulation seem to reduce the likelihood of oxygen convulsions in animals. No human studies have ever been done. Thus, at least a theoretical reason exists why pseudoephedrine should be avoided while diving on high PO2 dives."

Just a thought.

 

[dtdiver]

i'm glad you emerged alright.
but perhaps the key lies in your words:

"Didn't feel real good when I woke up this morning"
hmmmm. foreshadowing an event? feeling ill AND being congested sounds like a viral "prodrome". in other words, you were coming with a bug.

"took a pseudophed (4 am, and then another at ? o'clock),"
what type? extended (24 hour) or regular (4-6hour), did you take any aspirin or other pain relievers that would mask symptoms. with me , the pseudophed and the excitement and anticipation of something can get one so jazzed up i might ignore feeling bad.

"I thought maybe just a little tired and slowed down a bit"
sounds like you felt ill and might have been minimizing your true symptoms, meaning you really felt sick or tired but didn't want to admit it! had you eaten and hydrated normally?

"others went up from the floor to go through and I followed "
i'm not a caver but you didn't feel well but went into an overhead environment??
and you went in LAST?
i'm glad you were ok but doesn't this contradict some cardinal rule of caving?

"I signaled the other divers and they came back"
man, you must be thankful you didn't seize or have some sort of event. there would have been noone there to help.
and you felt better after drinking and/or eating something!
!food and hydration are good!

"Lesson learned Watch how, what and when I take Sudafed."
i would add. listen to your body, if you're not right , you are not right. cancel the dive. it's also far easier to blame the pseudophed than your own judgement

i'm not tryin to be caustic, just trying to understand so i can avoid the same sort of thing if it happens to me .

dt

 

[fgray1]

i'm glad you emerged alright.
but perhaps the key lies in your words:

"Didn't feel real good when I woke up this morning"
hmmmm. foreshadowing an event? feeling ill AND being congested sounds like a viral "prodrome". in other words, you were coming with a bug.

"took a pseudophed (4 am, and then another at ? o'clock),"
what type? extended (24 hour) or regular (4-6hour), did you take any aspirin or other pain relievers that would mask symptoms. with me , the pseudophed and the excitement and anticipation of something can get one so jazzed up i might ignore feeling bad.

"I thought maybe just a little tired and slowed down a bit"
sounds like you felt ill and might have been minimizing your true symptoms, meaning you really felt sick or tired but didn't want to admit it! had you eaten and hydrated normally?

"others went up from the floor to go through and I followed "
i'm not a caver but you didn't feel well but went into an overhead environment??
and you went in LAST?
i'm glad you were ok but doesn't this contradict some cardinal rule of caving?

"I signaled the other divers and they came back"
man, you must be thankful you didn't seize or have some sort of event. there would have been noone there to help.
and you felt better after drinking and/or eating something!
!food and hydration are good!

"Lesson learned Watch how, what and when I take Sudafed."
i would add. listen to your body, if you're not right , you are not right. cancel the dive. it's also far easier to blame the pseudophed than your own judgement

i'm not tryin to be caustic, just trying to understand so i can avoid the same sort of thing if it happens to me .

dt

As stated previously
I was on air.
I was in a cave where you can't dive side by side most times.We were 3 ft apart in single file.
I hadn't taken a Sudafed in the morning. Normaly I would have if I was stuffed up and then Dove long after it was in my system, usualy 2 to 3 hours later.
I was in a high flow cave where you have to pull and glide to move forward. It's alot of work.
I'm 49 years old and in good shape.
I took the Sudafed about 10 minutes before I went into the water. It was a red one 30 milligrams.
I didn't drink alot of water that morning and normally I would have drank at least a quart before going in to avoid cramps
I normaly don't eat before diving because if I do I'll have to wait for 45 min till my daily fuction occurs. I run like clock work.
I feel bad every morning when I wake up (a simptom of aging.)
I had nothing in my stomach at all.
I made several mistakes preping for the dive. I changed my routine and didn't follow my insticts.
Now I'll goto the Doc and get checked out again and I guarantee I'll remember this lesson.
Fred

 

[Wildbill]

I'm glad that everything worked out and you got back to surface safely...good job on keeping a cool head. From what I know about drug effects and interactions your Px buddy explaination sounds pretty accurate. But I would go see your Doctor just to be sure. In the past when you took the Sudafed you probably had also eaten something along the way and that would have absorbed some of the medicine and it didn't hit your system all at once.

Again, cudos on keeping a cool head.

Wildbill:cop_2:

 

[Wendy]

You didn't mention what type of gas you were breathing but from the type of diving you were doing, cave diving, I would guess it was some sort of oxygen enriched mix. I was of the belief that Sudafed wasn't to be taken when breathing oxygen enriched gas mixes as could predispose you to oxygen toxicity. Some of the symptoms you discribed sound as though that may be a possibility.

I found this info in the net...

Muscle twitching and spasm
nausea and vomiting
dizziness
vision (tunnel vision) and hearing difficulties (tinnitus)
twitching of facial muscles
irritability, confusion and a sense of impending doom
trouble breathing, anxiety
unusual fatigue
incoordination
convulsion.

Factors increasing risk of O2 toxicity

Increasing exposure time
Increasing depth
Increasing the percentage of inspired O2 (As in nitrox mixtures)
The simple act of immersion setting off the diving reflex
Exercise increasing the metabolic rate
Increased CO2 in the tissues (May be due to cerebral vasodilation)
Cold stress (Shivering is a form of exercise)Systemic diseases that increase the metabolic rate (such as thyroid diseases)
Sympathomimetic drugs (Drugs that mimic adrenalin in effect).

Sudafed is a medication often used by divers due to it's decongestive effect. It has few side effects but is a sympathomimetic drug (pseudephedrine). Whether or not it should be used in nitrox or rebreather diving is discussed by Dr. E.D. Thalmann in DAN's publication at http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=51

"In 1962, none other than DAN's Chief Executive Officer, Dr. Peter Bennett, while working as a research physiologist at the Royal Navy Physiological Laboratory in England, published a paper (Life Sciences; 12:721-727, 1962) testing the hypothesis that oxygen toxicity and nitrogen narcosis were caused by similar mechanisms.

He found that in rats, sympathomimetics seemed to enhance oxygen toxicity. Pseudoephedrine was not tested specifically, but it is a sympathomimetic, so we might infer that it has a similar effect. In addition, our current understanding of the mechanisms which produce oxygen convulsions would predict that sympathomimetic drugs might enhance susceptibility to oxygen convulsions. It has been shown that drugs which inhibit sympathetic stimulation seem to reduce the likelihood of oxygen convulsions in animals. No human studies have ever been done. Thus, at least a theoretical reason exists why pseudoephedrine should be avoided while diving on high PO2 dives."

Just a thought.

Thanks for posting the DAN stuff, I was just thinking about this when I read this thread. I also here that Afrin is something else to stay away from when diving nitrox or other higher O2 mixes. Although in this case he was diving air, I wonder if things would have been more tragic had he been on nitrox? I have seen a diver die, no medical history, just had been stuffy and took Afrin and/or sudafed.

Personally, If I don't feel good I thumb the dive before I ever leave the house. I would never taken meds before a dive, not even 24 hoyurs prior to a dive. Its just not you that you have to think about, you are part of a buddy team. If it had just been you and one other diver, and that diver had a problem, and you could not assist cuz of your problem, the poop would have really hit the fan.

Just glad you are ok this time.