Accident involving a “caustic cocktail” while diving with a closed-circuit rebreather

A 61 year old male presented himself with dyspnea, odynophagia and intraoral pain after suffering from an ingestion and inhalation traumata while diving with a closed-circuit rebreather at a depth of 21 m. Because of improper maintenance, residual condensation came in contact with the soda lime and formed a strong caustic soda, know to divers as “caustic cocktail”.

The treatment of the caustic alkali burns was the primary therapeutic target, after a decompression sickness was ruled out. Gastroesophagoscopy showed superficial mucosal burns, laryngoscopy revealed a non reduced glottic space, but the vocal cords were fibrin loaded. In the progress, the patient developed a pneumonia with respiratory insufficiency, which improved rapidly under iv- systemic antibiotics and antispasmodics. The patient was discharged after eight days. Three weeks later he was symptom-free, except for a hoarseness caused by residual laryngeal coatings.

In diving accidents with rebreather devices, in addition to the clarification of a decompression sickness should be carried out in parallel a clarification of caustic burns by dangerous leaching. This can lead to pulmonary restrictions that go unnoticed in everyday life. Therefore, the continuation of the diving sport should take place after a diving medical examination at the earliest after three months.

Publication History

Publication Date:
23 April 2019 (online)