Mailing List Archive

Mailing List: techdiver

Banner Advert

Message Display

Date: Sat, 6 Jul 1996 19:05:43 -0700 (PDT)
From: "Peter N.R. Heseltine" <heseltin@hs*.us*.ed*>
To: Richard Pyle <deepreef@bi*.bi*.Ha*.Or*>
cc: techdiver@terra.net
Subject: Re: DCS, body mass and nitrogen dosing
Rich,

My purpose here is not to add *unknown*, or more accurately unquantifiable
variables to the algorithms of nitrogen absorption, but to add a *known*
variable, using straightforward pharmacokinetic principles.

Over the past twenty years, the science of pharmacokinetics, the study of
distribution and elimination of drugs has entered into the mainstream of
medical care. Most drugs we ingest (like nitrogen) have some leeway
between the therapeutic and toxic doses. Chaos math may have some
application in determining stochastic events (like sudden, life
threatening allergy to a drug) but most of the time, pharmacokinetic
modeling (just like N2 absorption algorithms) deal with what happens to
most folks.


The Navy and other tables for NDL were developed empirically,
tested and modified by actual experience. This is analogous to Phase I
testing of a new drug. DAN is collecting data and profiles on a million
"sport" dives. This is similar to post-marketing testing of a drug; N2 in
this case. Now if you believe that all DCI events are stochastic then the
latter type of study or analyses of the data will not be helpful in
preventing them. Similarly, we can postulate all sorts and types of other
variables that *may* affect the incidence of DCI. But the
pharmacokinetics of nitrogen is what the tables (and algorithms) are all
about. This is not a *new* variable like, say the effect of complement on
bubble mechanics.


My point is this: You cannot accurately model the distribution and
elimination of a drug without knowing the volume of distribution (Vd) in
the body of that drug. You can't determine the Vd unless
you know something about the size of that "body" i.e.,person. If the
relative concentration of the drug is small in relationship to the volume
of distribution, big variations in body mass can occur without
changing the concentration greatly. A two fold increase in Vd halves the
concentration, but if it goes from 0.008 mg/dl to 0.004 mg/dl, it probably
won't have much biologic/pharmacologic effect. But nitrogen is present in
high concentration in our bodies (~79%, maybe less). So differences in
body size and so Vd are likely to play a *great* role in N2 elimination.

It wasn't taken into account in the tables, because without some way of
measuring the number of breaths taken at a given depth, not just the total
gas breathed, it is almost impossible to know whether you were on-gassing
or off-gassing a compartment at that moment. But now with air integrated
computers, it is possible.

I still think that the tables can be improved through the application of
other medical disciplines, anesthesiology, physiology, pharmacology. I may
be wrong, but I'll learn a lot trying.

Safer diving through wiser physiology

Peter Heseltine

Navigate by Author: [Previous] [Next] [Author Search Index]
Navigate by Subject: [Previous] [Next] [Subject Search Index]

[Send Reply] [Send Message with New Topic]

[Search Selection] [Mailing List Home] [Home]