Salt water aspiration syndrome

Overview

Salt water aspiration syndrome (SWAS) is a mild but notable respiratory condition that occurs when seawater or other salt water is inhaled into the lungs, typically during scuba diving, snorkeling, or other aquatic activities. Unlike full drowning or near-drowning events, SWAS usually involves the inhalation of small amounts of water, enough to irritate the lungs but not cause immediate life-threatening asphyxia. Despite its relatively benign course in most cases, it can cause considerable discomfort and requires prompt recognition and appropriate care.

This syndrome is most commonly observed in divers who may accidentally aspirate salt water through faulty equipment or due to poor technique. The condition is characterized by a delayed onset of respiratory symptoms, including coughing, shortness of breath, and chest tightness, often developing within hours of water exposure. Although symptoms typically resolve with supportive care, SWAS must be distinguished from more serious conditions like pulmonary edema or aspiration pneumonia.

Causes

Salt water aspiration syndrome is caused by the inhalation of small amounts of salt water into the airways and lungs. This can occur in a variety of scenarios, most notably:

• Scuba diving: Improper use of regulators, faulty valves, or poor mask seal may lead to seawater entry into the airways

• Snorkeling or swimming: Swallowing or choking on water while breathing through a snorkel or surfacing improperly

• Rough sea conditions: Increased risk of water splashing into the mouth or nose while attempting to breathe

• Panic or inexperience: Novice divers or swimmers may aspirate water due to panic, incorrect breathing, or lack of control

When salt water is inhaled, it irritates the airway lining and may cause an inflammatory response. The high salt concentration can draw fluid into the lungs, leading to mild pulmonary edema-like symptoms even without a large volume of water entering the airways.

Symptoms

Symptoms of salt water aspiration syndrome typically develop within 1 to 12 hours after the exposure. Common signs and symptoms include:

• Coughing: Often persistent and may be accompanied by a salty or metallic taste

• Chest discomfort: Mild pain or a feeling of tightness in the chest

• Shortness of breath: Difficulty breathing or a sensation of not getting enough air, especially with exertion

• Fatigue: General tiredness or malaise following diving activity

• Wheezing or crackles: Audible lung sounds due to airway irritation or fluid presence

• Mild fever: Occasionally present, though high fever suggests a more serious condition such as infection

Symptoms are usually self-limited but may last for up to 24 to 72 hours. In rare cases, the condition may progress or lead to secondary complications like infection if not managed properly.

Diagnosis

Diagnosis of salt water aspiration syndrome is primarily clinical, based on a detailed history of recent aquatic activity and the development of respiratory symptoms. Diagnostic steps may include:

• Medical history: Inquiry into recent diving, snorkeling, or swimming incidents, including any episodes of choking or equipment malfunction

• Physical examination: Assessment of breath sounds, oxygen saturation, and respiratory effort

• Pulse oximetry: To measure blood oxygen levels, which are often mildly reduced

• Chest X-ray: May show mild interstitial changes or patchy infiltrates; used to rule out more serious conditions like aspiration pneumonia or pulmonary edema

• Blood tests: Usually not required unless infection or other complications are suspected

It is important to differentiate SWAS from more severe pulmonary conditions, including decompression illness, chemical pneumonitis, and cardiogenic pulmonary edema.

Treatment

Most cases of salt water aspiration syndrome are mild and resolve with conservative, supportive treatment. Common approaches include:

• Rest: Avoid physical exertion for at least 24 to 48 hours

• Oxygen therapy: Supplemental oxygen may be given if oxygen saturation is low

• Bronchodilators: Inhaled medications may help if there is significant wheezing or bronchospasm

• Hydration: Encouraging oral fluids unless contraindicated

• Observation: Monitoring for signs of deterioration or secondary infection

Antibiotics are not routinely indicated unless there is evidence of secondary bacterial infection (e.g., persistent fever, productive cough with purulence). Hospitalization is rarely required unless symptoms are severe or not improving within 48–72 hours.

Prognosis

The prognosis for individuals with salt water aspiration syndrome is generally excellent. Most people recover fully within a few days without lasting effects. Early recognition and supportive care are key to preventing complications.

However, divers or swimmers who have experienced SWAS should be cautious about returning to aquatic activities too soon. A full recovery and symptom resolution are recommended before resuming diving or swimming. In rare cases, unresolved aspiration or poor post-exposure care can lead to more serious outcomes like pneumonia or long-term pulmonary dysfunction.

With proper education on diving techniques and safety, the risk of salt water aspiration syndrome can be significantly reduced.