Caustic cocktail

Background

• Accident/injury that can occur to rebreather divers
• Occurs when absorbent material (commonly Sofnolime and Intersorb) used to scrub CO2 from breathing gas is inundated with water
• Significant water + absorbent medium --> highly corrosive alkaline-based liquid containing calcium or sodium hydroxide
• Inhaling this liquid--> caustic chemical burns to lungs

Clinical Features

• Chemical burns to oropharyngeal mucosa/airways/lungs
• Mouth/throat/chest pain
• Cough, hemoptysis, SOB, respiratory distress
• Laryngospasm, bronchospasm

Differential Diagnosis

Diving Emergencies

• Barotrauma of descent
  • Otic barotrauma
  • Pulmonary barotrauma
  • Sinus barotrauma
  • Mask squeeze
  • Barodentalgia (trapped dental air causing squeeze)
• Barotrauma of ascent
  • Pulmonary barotrauma (pulmonary overpressurization syndrome)
  • Decompression sickness (DCS)
  • Arterial gas embolism
  • Alternobaric vertigo
  • Facial baroparesis (Bells Palsy)
• At depth injuries
  • Oxygen toxicity
  • Nitrogen narcosis
  • Hypothermia
  • Contaminated gas mixture (e.g. CO toxicity)
  • Caustic cocktail from rebreathing circuit

Management

• Supportive