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2017 ; 6
(2
): 200-205
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Acute kidney injury caused by decompression illness successfully treated with
hyperbaric oxygen therapy and temporary dialysis
#MMPMID28900861
Hibi A
; Kamiya K
; Kasugai T
; Kamiya K
; Kominato S
; Ito C
; Miura T
; Koyama K
CEN Case Rep
2017[Nov]; 6
(2
): 200-205
PMID28900861
show ga
A 52-year-old Japanese male professional diver was referred to our hospital for
decompression illness (DCI). After 1 h of diving operation at 20 m below sea
level, he complained of dyspnea, chest pain, and abdominal pain. He dove again,
intending to ease the symptoms, but the symptoms were never relieved. He dove for
a total of 4 h. No neurological abnormalities were observed. Computed tomography
images revealed portal venous gas and mesenteric venous gas, in addition to
bubbles in the femoral veins, pelvis, lumbar canal, intracranial sinuses, and
joints. Hyperbaric oxygen therapy (HBOT) was immediately administered. His
symptoms improved after the first course of HBOT, however, the patient had anuria
for almost 36 h after admission and exhibited acute kidney injury (AKI). Serum
creatinine and creatine kinase (CK) levels were increased to maximal values of
6.16 mg/dL and 18,963 U/L, respectively. Blood flow signals were not detected on
kidney Doppler ultrasound. We considered that AKI was caused by blood flow
impairment and capillary leak syndrome due to DCI in addition to rhabdomyolysis
secondary to arterial gas embolism in the skeletal muscles. Temporary dialysis
was required to correct the acidemia and electrolyte disturbance. Diuretic phase
was initiated, and the patient was put off dialysis on day 3. Serum creatinine
and CK levels returned to normal on day 11. He was successfully treated without
any complications. Although AKI is a rare manifestation, we should consider AKI
risk in patients with severe DCI.
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