Amiloride Hydrochloride

[Crowley]

Hi there,

I have a potential student who is taking Amiloride HCl for a low potassium problem to deal with a rare condition called Gitelman's syndrome.

All the information I can find suggests that this is a big no-no for scuba diving given that it is also a high blood pressure medication, but I cannot find any medical advice relating to this particular drug and scuba diving.

There is no doctor on this island who would be able to give me an accurate medical confirmation, and I have requested a full medical from his doctor back home. If anybody has any information regarding this, I'd be happy to hear it because the more I read, the more convinced I am that this is not a medication that somebody should be taking to 30 metres on an AOW course.

Cheers

Crowley

 

[DocVikingo]

Hi Crowley,

Gitelman's syndrome (GS) is a rare, heritable kidney disorder characterized by hypomagnesaemia (low serum magnesium), hypokalemia (low serum potassium) & hypocalciuria (low urine calcium). These electrolytes, along with sodium, play very important roles in many bodily functions, including nervous system activity in the heart & brain. As such, abnormalities in levels can cause cardiac arrhythmias or difficulty thinking, concentrating & focussing (aka "brain fog"). In addition to these, signs/symptoms of GS of possible consequence for scuba include generalized weakness & fatigue, muscle cramping & excessive urination. A reduction in exercise tolerance is an obvious concern.

In GS, amiloride hydrochloride (e.g., Midamor) is used to prevent the development of low serum potassium/restore normal serum potassium levels. It's usually well tolerated, but can cause potentially serious high potassium levels. Side effects of possible consequence for scuba include slowed heartbeat, weakened pulse, dizziness & headache.

The implications of scuba for the condition have not been studied but would theoretically include worsening of signs/sxs by thermal & immersion-related increases in urination.

Requesting medical clearance from a diving medicine specialist appears prudent. It is unlikely that the diver’s PCP will have the specialized knowledge required to make the call on scuba.

Regards,

DocVikingo

This is educational only and does not constitute or imply a doctor-patient relationship. It is not medical advice to you or any other individual, and should not be construed as such.

 

[TSandM]

It is an interesting question, actually. This is one case where the fluid shifts associated with diving might actually have a significant impact and change the relationship of the diver to his medication. If the patient has been on a stable dose of medication with stable electrolytes for some time, I don't think I would refuse to clear him for diving, but simply suggest that he should keep his initial experiences relatively shallow and short, until he's sure that everything goes well. (Shallow, not because depth will affect this, but because if he starts to feel weak or shaky, he can get out of the water easier.) If he's been actively diving without issues, I think the likelihood of them cropping up simply because he's diving deeper is low.

 

[Duke Dive Medicine]

Ditto DocV. The medication has some serious potential side effects, but the disease process itself is of equal or greater concern. I think he needs to be examined and cleared by a diving physician.

Best regards,
DDM

 

[TSandM]

BTW, my post is predicated on the fact that he is already certified (clear by the fact that he's signed up for an ADVANCED open water class) and therefore was cleared by a physician for his initial class, AND has been diving, one would assume without issues, at the open water level.

 

[DocVikingo]

Hi Crowely,

Any chance you can give us a bit more info on this diver so that we can work more with facts than with predication & assumption?

For example:

1. Was the diver on amiloride at the time of his cert at the OW level?
2. If the answer to #1 is "yes," did he actually receive clearance from a physician for his initial class?
3. If the answer to #2 is "yes," was it a diving medicine doctor? (Given the nature of the disease & of scuba, this is of more than academic interest).
4. Has he been actively diving since obtaining OW cert?
5. If the answer to #4 is "yes," has he been doing so without issues?
6. Does he have any other medical conditions of concern to safe scuba?

Cheers,

DocV