Decompression illness with hypovolemic shock and neurological failure symptoms after two risky dives: a case report

Abstract

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.

Keywords: Decompression illness; hypovolemic shock syndrome; patent foramen ovale; systemic inflammatory response syndrome.

Figure 1

Dive profiles (dive 1 left, dive 2 right) in comparison to US Navy/German Navy standards. Both dives made several decompression stages necessary, which the patient had not completely fulfilled. Furthermore, surface time of 76 min between the dives was inadequate short.

Figure 2

(A) Magnetic resonance imaging scan of the head (diffusion‐weighted imaging) multiple cerebral thromboembolisms according to the central region, superior, and middle frontal gyrus. (B) CT scan of the chest 6 h after the first symptoms: multiple pulmonary thromboembolisms of the segmental arteries. Follow‐up CT scans of the chest 9 h later: no pulmonary thromboembolism of the same segmental arteries. CT, computed tomography; DWI, diffusion‐weighted imaging.