DAN Medical Frequently Asked Questions

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Immersion Pulmonary Edema

I was recently diving and while at depth I began to have a hard time breathing. I made a controlled ascent and began coughing up pink frothy fluid. I was taken to the hospital. The doctor there insisted it was a near drowning. I did not inhale any sea water. I think it was something else.

Originally, IPE was thought to occur
almost exclusively in cold water. While
this condition seems to be more common
in cold water, it has also been reported
in warm waters.
During immersion in water, blood is
redistributed from the legs to the heart
and blood vessels in the lungs. Usually
the heart and lungs compensate for this,
but sometimes the resulting increased
pressure within the blood vessels in the
lungs causes fluid to traverse the small
vessels (capillaries) and enter the gascontaining
spaces of the lungs.
Sometimes this is caused by an underwater
myocardial infarction (heart attack),
abnormalities of the heart muscle or heart
valves or hypertension. Usually there is
no obvious cause.
Cold water may be a predisposing factor
because immersion can cause the small
arteries to constrict, increasing the
resistance to the flow of blood. Vasoconstriction
in response to cold can be
exaggerated in people with hypertension
or those likely to develop it. But some
people who experience IPE are young
and healthy, even military recruits.
Immediate treatment should include
breathing oxygen while in transit to a
hospital. Some IPE cases have been fatal,
although most cases resolve on their own
during observation in a hospital. A closer
examination may reveal hypertension,
a heart attack, cardiac valve disease or
impaired contraction of the heart.
Divers who have experienced IPE are
concerned with the likelihood it will
recur. Unfortunately, that likelihood is not
known, so many physicians recommend
that people with a history of IPE not
return to diving. Still others recommend
taking an antihypertensive medication
before each dive. Before considering a
return to diving after IPE, DAN recommends
the diver consult with a doctor
knowledgeable about the condition.