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Following the recent discussion on this subject under the "DIR or not" thread on the Equipment board, I had a look at what the Internet says. Although fluid replacement (by i.v. infusion) is an essential part of chamber treatment and people are recommended to drink plenty of fluids AFTER chamber treatment, the question of oral administration of fluids as part of first aid treatment of DCI victims is apparently still very controversial. For example, Dr Simon Mitchell http://www.divenewzealand.com/48divemed.html writes as follows:
"For a variety of reasons, divers tend to be dehydrated. Dehydration is thought to be a risk factor for the exacerbation of DCI, although there is little solid evidence. Nevertheless, correction of dehydration is a priority in treatment at hyperbaric units. The aggressiveness with which rescuers in the field should attempt to correct dehydration has always been a controversial subject. If someone qualified to initiate and maintain an intravenous fluid infusion is present, then this should always be done. The situation is less clear for oral fluids. There is a risk that if oral fluids are taken and the patient’s condition deteriorates, then they might become unconscious and aspirate the fluids into their lungs. If the patient’s level of consciousness is decreased, or if they have rapidly progressive disease, then I would withhold oral fluids. I would also advise against oral fluids if the diver is likely to be in the care of someone qualified to start an intravenous infusion within 45-60 minutes. Where the patient is fully conscious and stable, and rescue is likely to be delayed longer than 45-60 minutes, bland oral fluids should be given in frequent small amounts. The horizontal position should not be compromised in order to administer fluid. In this regard, those trendy water bottles with straws (which are otherwise only useful for passing disease from person to person!) can come into their own. The amount given should always be recorded."
As regards what to give (if anything), I suspect the recommendation to give apple juice (or other fruit juices) rather than water, as discussed previously, is actually based on the assumption that a person who is dehydrated probably also has an electrolyte disturbance (potassium deficiency etc) but, surely, this is unlikely to be the case unless he or she has diarrhoea or has vomited heavily. Failure to drink enough fluids before diving, especially in hot weather, may well lead to dehydration but I'd have thought a DCI victim would be unlikely to have sweated so copiously in normal Northern European weather conditions as to have developed a serious electrolyte imbalance, or am I wrong about this?
Following the recent discussion on this subject under the "DIR or not" thread on the Equipment board, I had a look at what the Internet says. Although fluid replacement (by i.v. infusion) is an essential part of chamber treatment and people are recommended to drink plenty of fluids AFTER chamber treatment, the question of oral administration of fluids as part of first aid treatment of DCI victims is apparently still very controversial. For example, Dr Simon Mitchell http://www.divenewzealand.com/48divemed.html writes as follows:
"For a variety of reasons, divers tend to be dehydrated. Dehydration is thought to be a risk factor for the exacerbation of DCI, although there is little solid evidence. Nevertheless, correction of dehydration is a priority in treatment at hyperbaric units. The aggressiveness with which rescuers in the field should attempt to correct dehydration has always been a controversial subject. If someone qualified to initiate and maintain an intravenous fluid infusion is present, then this should always be done. The situation is less clear for oral fluids. There is a risk that if oral fluids are taken and the patient’s condition deteriorates, then they might become unconscious and aspirate the fluids into their lungs. If the patient’s level of consciousness is decreased, or if they have rapidly progressive disease, then I would withhold oral fluids. I would also advise against oral fluids if the diver is likely to be in the care of someone qualified to start an intravenous infusion within 45-60 minutes. Where the patient is fully conscious and stable, and rescue is likely to be delayed longer than 45-60 minutes, bland oral fluids should be given in frequent small amounts. The horizontal position should not be compromised in order to administer fluid. In this regard, those trendy water bottles with straws (which are otherwise only useful for passing disease from person to person!) can come into their own. The amount given should always be recorded."
As regards what to give (if anything), I suspect the recommendation to give apple juice (or other fruit juices) rather than water, as discussed previously, is actually based on the assumption that a person who is dehydrated probably also has an electrolyte disturbance (potassium deficiency etc) but, surely, this is unlikely to be the case unless he or she has diarrhoea or has vomited heavily. Failure to drink enough fluids before diving, especially in hot weather, may well lead to dehydration but I'd have thought a DCI victim would be unlikely to have sweated so copiously in normal Northern European weather conditions as to have developed a serious electrolyte imbalance, or am I wrong about this?
