Carbon monoxide poisoning

Other names: Carbon monoxide intoxication, carbon monoxide toxicity, carbon monoxide overdose
Carbon monoxide
Specialty| Toxicology, emergency medicine
Symptoms| Headache, dizziness, weakness, vomiting, chest pain, confusion[1]
Complications| Loss of consciousness, arrhythmias, seizures[1][2]
Causes| Breathing in carbon monoxide[3]
Diagnostic method| Carboxyl-hemoglobin level:
3% (nonsmokers)
10% (smokers)[2]
Differential diagnosis| Cyanide toxicity, alcoholic ketoacidosis, aspirin poisoning, upper respiratory tract infection[2][4]
Prevention| Carbon monoxide detectors, venting of gas appliances, maintenance of exhaust systems[1]
Treatment| Supportive care, 100% oxygen, hyperbaric oxygen therapy[2]
Prognosis| Risk of death 1–31%.[2]
Frequency| >20,000 emergency visits for non-fire related cases per year (US)[1]
Deaths| >400 non-fire related a year (US)[1]

Carbon monoxide poisoning typically occurs from breathing in carbon monoxide (CO) at excessive levels.[3] Symptoms are often described as "flu-like" and commonly include headache, dizziness, weakness, vomiting, chest pain, and confusion.[1] Large exposures can result in loss of consciousness, arrhythmias, seizures, or death.[1][2] The classically described "cherry red skin" rarely occurs.[2] Long term complications may include feeling tired, trouble with memory, and movement problems.[5] In those exposed to smoke, cyanide toxicity should also be considered.[2]

Carbon monoxide poisoning can occur accidentally, as an attempt to end one's own life, or as an attempt to end another's life.[6][7] CO is a colorless and odorless gas which is initially non-irritating.[5] It is produced during incomplete burning of organic matter.[5] This can occur from motor vehicles, heaters, or cooking equipment that run on carbon-based fuels.[1] It can also occur from exposure to methylene chloride.[8] Carbon monoxide primarily causes adverse effects by combining with hemoglobin to form carboxyhemoglobin (HbCO) preventing the blood from carrying oxygen.[5] Additionally, myoglobin and mitochondrial cytochrome oxidase are affected.[2] Diagnosis is based on a HbCO level of more than 3% among nonsmokers and more than 10% among smokers.[2]

Efforts to prevent poisoning include carbon monoxide detectors, proper venting of gas appliances, keeping chimneys clean, and keeping exhaust systems of vehicles in good repair.[1] Treatment of poisoning generally consists of giving 100% oxygen along with supportive care.[2][5] This should generally be carried out until symptoms are no longer present and the HbCO level is less than 10%.[2] While hyperbaric oxygen therapy is used for severe poisonings, the benefit over standard oxygen delivery is unclear.[2][6] The risk of death among those affected is between 1 and 30%.[2]

Carbon monoxide poisoning is relatively common, resulting in more than 20,000 emergency room visits a year in the United States.[1][9] It is the most common type of fatal poisoning in many countries.[10] In the United States, non-fire related cases result in more than 400 deaths a year.[1] Poisonings occur more often in the winter, particularly from the use of portable generators during power outages.[2][8] The toxic effects of CO have been known since ancient history.[11] The discovery that hemoglobin is affected by CO was made in 1857.[11]

## Contents

* 1 Signs and symptoms
* 1.1 Acute poisoning
* 1.2 Chronic poisoning
* 2 Causes
* 3 Pathophysiology
* 3.1 Hemoglobin
* 3.2 Myoglobin
* 3.3 Cytochrome oxidase
* 3.4 Central nervous system effects
* 3.5 Pregnancy
* 4 Diagnosis
* 4.1 Measuring
* 4.2 Differential diagnosis
* 5 Prevention
* 5.1 Detectors
* 5.2 Legal requirements
* 5.3 Air quality
* 6 Treatment
* 6.1 Hyperbaric oxygen
* 6.2 Other
* 7 Epidemiology
* 8 History
* 9 Research
* 10 References
* 11 External links

## Signs and symptoms[edit | edit source]

Carbon monoxide is not toxic to all forms of life. Its harmful effects are due to binding with hemoglobin so its danger to organisms that do not use this compound is doubtful. It thus has no effect on photosynthesising plants.[12] It is easily absorbed through the lungs.[13] Inhaling the gas can lead to hypoxic injury, nervous system damage, and even death. Different people and populations may have different carbon monoxide tolerance levels.[14] On average, exposures at 100 ppm or greater is dangerous to human health.[15] In the United States, the OSHA limits long-term workplace exposure levels to less than 50 ppm averaged over an 8-hour period;[16][17] in addition, employees are to be removed from any confined space if an upper limit ("ceiling") of 100 ppm is reached.[18] Carbon monoxide exposure may lead to a significantly shorter life span due to heart damage.[19] The carbon monoxide tolerance level for any person is altered by several factors, including activity level, rate of ventilation, a pre-existing cerebral or cardiovascular disease, cardiac output, anemia, sickle cell disease and other hematological disorders, barometric pressure, and metabolic rate.[20][21][22]

Effects of carbon monoxide in relation to the concentration in parts per million in the air:[23][24] Concentration  | Symptoms

|

35 ppm (0.0035%), (0.035‰)  | Headache and dizziness within six to eight hours of constant exposure
100 ppm (0.01%), (0.1‰)  | Slight headache in two to three hours
200 ppm (0.02%), (0.2‰)  | Slight headache within two to three hours; loss of judgment
400 ppm (0.04%), (0.4‰)  | Frontal headache within one to two hours
800 ppm (0.08%), (0.8‰)  | Dizziness, nausea, and convulsions within 45 min; insensible within 2 hours
1,600 ppm (0.16%), (1.6‰)  | Headache, increased heart rate, dizziness, and nausea within 20 min; death in less than 2 hours
3,200 ppm (0.32%), (3.2‰)  | Headache, dizziness and nausea in five to ten minutes. Death within 30 minutes.
6,400 ppm (0.64%), (6.4‰)  | Headache and dizziness in one to two minutes. Convulsions, respiratory arrest, and death in less than 20 minutes.
12,800 ppm (1.28%), (12.8‰)  | Unconsciousness after 2–3 breaths. Death in less than three minutes.

### Acute poisoning[edit | edit source]

CO toxicity symptoms

The main manifestations of carbon monoxide poisoning develop in the organ systems most dependent on oxygen use, the central nervous system and the heart.[16] The initial symptoms of acute carbon monoxide poisoning include headache, nausea, malaise, and fatigue.[25] These symptoms are often mistaken for a virus such as influenza or other illnesses such as food poisoning or gastroenteritis.[26] Headache is the most common symptom of acute carbon monoxide poisoning; it is often described as dull, frontal, and continuous.[27] Increasing exposure produces cardiac abnormalities including fast heart rate, low blood pressure, and cardiac arrhythmia;[28][29] central nervous system symptoms include delirium, hallucinations, dizziness, unsteady gait, confusion, seizures, central nervous system depression, unconsciousness, respiratory arrest, and death.[30][31] Less common symptoms of acute carbon monoxide poisoning include myocardial ischemia, atrial fibrillation, pneumonia, pulmonary edema, high blood sugar, lactic acidosis, muscle necrosis, acute kidney failure, skin lesions, and visual and auditory problems.[28][32][33][34]

One of the major concerns following acute carbon monoxide poisoning is the severe delayed neurological manifestations that may occur. Problems may include difficulty with higher intellectual functions, short-term memory loss, dementia, amnesia, psychosis, irritability, a strange gait, speech disturbances, Parkinson's disease-like syndromes, cortical blindness, and a depressed mood.[26][35] Depression may occur in those who did not have pre-existing depression.[36] These delayed neurological sequelae may occur in up to 50% of poisoned people after 2 to 40 days.[26] It is difficult to predict who will develop delayed sequelae; however, advanced age, loss of consciousness while poisoned, and initial neurological abnormalities may increase the chance of developing delayed symptoms.[37]

One classic sign of carbon monoxide poisoning is more often seen in the dead rather than the living – people have been described as looking red-cheeked and healthy (see below). However, since this "cherry-red" appearance is more common in the dead, it is not considered a useful diagnostic sign in clinical medicine. In autopsy examinations, the ruddy appearance of carbon monoxide poisoning is notable because unembalmed dead persons are normally bluish and pale, whereas dead carbon-monoxide poisoned people may appear unusually lifelike in coloration.[38][39][40] The colorant effect of carbon monoxide in such postmortem circumstances is thus analogous to its use as a red colorant in the commercial meat-packing industry.

### Chronic poisoning[edit | edit source]

Chronic exposure to relatively low levels of carbon monoxide may cause persistent headaches, lightheadedness, depression, confusion, memory loss, nausea, hearing disorders and vomiting.[41][42] It is unknown whether low-level chronic exposure may cause permanent neurological damage.[26] Typically, upon removal from exposure to carbon monoxide, symptoms usually resolve themselves, unless there has been an episode of severe acute poisoning.[41] However, one case noted permanent memory loss and learning problems after a three-year exposure to relatively low levels of carbon monoxide from a faulty furnace.[43] Chronic exposure may worsen cardiovascular symptoms in some people.[41] Chronic carbon monoxide exposure might increase the risk of developing atherosclerosis.[44][45] Long-term exposures to carbon monoxide present the greatest risk to persons with coronary heart disease and in females who are pregnant.[46] In experimental animals, carbon monoxide appears to worsen noise-induced hearing loss at noise exposure conditions that would have limited effects on hearing otherwise.[47] In humans, hearing loss has been reported following carbon monoxide poisoning.[42] Unlike the findings in animal studies, noise exposure was not a necessary factor for the auditory problems to occur.

## Causes[edit | edit source]

Concentration  | Source

|

0.1 ppm  | Natural atmosphere level (MOPITT)[48]
0.5 to 5 ppm  | Average level in homes[49]
5 to 15 ppm  | Near properly adjusted gas stoves in homes[49]
100 to 200 ppm  | Exhaust from automobiles in the Mexico City central area[50]
5,000 ppm  | Exhaust from a home wood fire[51]
7,000 ppm  | Undiluted warm car exhaust without a catalytic converter[51]
30,000 ppm  | Afterdamp following an explosion in a coal mine[52]

Carbon monoxide is a product of combustion of organic matter under conditions of restricted oxygen supply, which prevents complete oxidation to carbon dioxide (CO2). Sources of carbon monoxide include cigarette smoke, house fires, faulty furnaces, heaters, wood-burning stoves,[53] internal combustion vehicle exhaust, electrical generators, propane-fueled equipment such as portable stoves, and gasoline-powered tools such as leaf blowers, lawn mowers, high-pressure washers, concrete cutting saws, power trowels, and welders.[26][41][54][55][56][57][58] Exposure typically occurs when equipment is used in buildings or semi-enclosed spaces.[26]

Riding in the back of pickup trucks has led to poisoning in children.[59] Idling automobiles with the exhaust pipe blocked by snow has led to the poisoning of car occupants.[60] Any perforation between the exhaust manifold and shroud can result in exhaust gases reaching the cabin. Generators and propulsion engines on boats, especially houseboats, has resulted in fatal carbon monoxide exposures.[61][62]

Poisoning may also occur following the use of a self-contained underwater breathing apparatus (SCUBA) due to faulty diving air compressors.[63]

In caves carbon monoxide can build up in enclosed chambers due to the presence of decomposing organic matter.[64] In coal mines incomplete combustion may occur during explosions resulting in the production of afterdamp. The gas is up to 3% CO and may be fatal after just a single breath.[52] Following an explosion in a colliery, adjacent interconnected mines may become dangerous due to the afterdamp leaking from mine to mine. Such an incident followed the Trimdon Grange explosion which killed men in the Kelloe mine.[65]

Another source of poisoning is exposure to the organic solvent dichloromethane, also known as methylene chloride, found in some paint strippers,[66] as the metabolism of dichloromethane produces carbon monoxide.[67][68][69] In November 2019, an EPA ban on dichloromethane in paint strippers for consumer use took effect in the United States.[70]

## Pathophysiology[edit | edit source]

The precise mechanisms by which the effects of carbon monoxide are induced upon bodily systems, are complex and not yet fully understood.[25] Known mechanisms include carbon monoxide binding to hemoglobin, myoglobin and mitochondrial cytochrome c oxidase and restricting oxygen supply, and carbon monoxide causing brain lipid peroxidation.[30][38][71]

### Hemoglobin[edit | edit source]

Carbon monoxide shifts the oxygen-dissociation curve to the left.

Carbon monoxide has a higher diffusion coefficient compared to oxygen, and the only enzyme in the human body that produces carbon monoxide is heme oxygenase, which is located in all cells and breaks down heme. Under normal conditions, carbon monoxide levels in the plasma are approximately 0 mmHg because it has a higher diffusion coefficient and the body easily gets rid of any CO made.[72] When CO is not ventilated it binds to hemoglobin, which is the principal oxygen-carrying compound in blood; this produces a compound known as carboxyhemoglobin. The traditional understanding is that carbon monoxide toxicity arises from the formation of carboxyhemoglobin, which decreases the oxygen-carrying capacity of the blood and inhibits the transport, delivery, and utilization of oxygen by the body. The affinity between hemoglobin and carbon monoxide is approximately 230 times stronger than the affinity between hemoglobin and oxygen so hemoglobin binds to carbon monoxide in preference to oxygen.[38][73][74]

Hemoglobin is a tetramer with four oxygen binding sites. The binding of carbon monoxide at one of these sites increases the oxygen affinity of the remaining three sites, which causes the hemoglobin molecule to retain oxygen that would otherwise be delivered to the tissue.[71] This situation is described as carbon monoxide shifting the oxygen dissociation curve to the left.[38] Because of the increased affinity between hemoglobin and oxygen during carbon monoxide poisoning, little oxygen will actually be released in the tissues. This causes hypoxic tissue injury.[26] Hemoglobin acquires a bright red color when converted into carboxyhemoglobin, so poisoned cadavers and even commercial meats treated with carbon monoxide acquire an unnatural reddish hue.

### Myoglobin[edit | edit source]

Carbon monoxide also binds to the hemeprotein myoglobin. It has a high affinity for myoglobin, about 60 times greater than that of oxygen.[26] Carbon monoxide bound to myoglobin may impair its ability to utilize oxygen.[38] This causes reduced cardiac output and hypotension, which may result in brain ischemia.[26] A delayed return of symptoms have been reported. This results following a recurrence of increased carboxyhemoglobin levels; this effect may be due to a late release of carbon monoxide from myoglobin, which subsequently binds to hemoglobin.[10]

### Cytochrome oxidase[edit | edit source]

Another mechanism involves effects on the mitochondrial respiratory enzyme chain that is responsible for effective tissue utilization of oxygen. Carbon monoxide binds to cytochrome oxidase with less affinity than oxygen, so it is possible that it requires significant intracellular hypoxia before binding.[75] This binding interferes with aerobic metabolism and efficient adenosine triphosphate synthesis. Cells respond by switching to anaerobic metabolism, causing anoxia, lactic acidosis, and eventual cell death.[76] The rate of dissociation between carbon monoxide and cytochrome oxidase is slow, causing a relatively prolonged impairment of oxidative metabolism.[25]

### Central nervous system effects[edit | edit source]

The mechanism that is thought to have a significant influence on delayed effects involves formed blood cells and chemical mediators, which cause brain lipid peroxidation (degradation of unsaturated fatty acids). Carbon monoxide causes endothelial cell and platelet release of nitric oxide, and the formation of oxygen free radicals including peroxynitrite.[25] In the brain this causes further mitochondrial dysfunction, capillary leakage, leukocyte sequestration, and apoptosis.[77] The result of these effects is lipid peroxidation, which causes delayed reversible demyelinization of white matter in the central nervous system known as Grinker myelinopathy, which can lead to edema and necrosis within the brain.[71] This brain damage occurs mainly during the recovery period. This may result in cognitive defects, especially affecting memory and learning, and movement disorders. These disorders are typically related to damage to the cerebral white matter and basal ganglia.[77][78] Hallmark pathological changes following poisoning are bilateral necrosis of the white matter, globus pallidus, cerebellum, hippocampus and the cerebral cortex.[15][26][79]

### Pregnancy[edit | edit source]

Carbon monoxide poisoning in pregnant women may cause severe adverse fetal effects. Poisoning causes fetal tissue hypoxia by decreasing the release of maternal oxygen to the fetus. Carbon monoxide also crosses the placenta and combines with fetal hemoglobin, causing more direct fetal tissue hypoxia. Additionally, fetal hemoglobin has a 10 to 15% higher affinity for carbon monoxide than adult hemoglobin, causing more severe poisoning in the fetus than in the adult.[10] Elimination of carbon monoxide is slower in the fetus, leading to an accumulation of the toxic chemical.[80] The level of fetal morbidity and mortality in acute carbon monoxide poisoning is significant, so despite mild maternal poisoning or following maternal recovery, severe fetal poisoning or death may still occur.[81]

## Diagnosis[edit | edit source]

Finger tip carboxyhemoglobin saturation monitor (SpCO%). Note: This is not the same as a pulse oximeter (SpO2%), although some models (such as this one) do measure both the oxygen and carbon monoxide saturation.

Breath CO monitor displaying carbon monoxide concentration of an exhaled breath sample (in ppm) with its corresponding percent concentration of carboxyhemoglobin.

As many symptoms of carbon monoxide poisoning also occur with many other types of poisonings and infections (such as the flu), the diagnosis is often difficult.[69][82] A history of potential carbon monoxide exposure, such as being exposed to a residential fire, may suggest poisoning, but the diagnosis is confirmed by measuring the levels of carbon monoxide in the blood. This can be determined by measuring the amount of carboxyhemoglobin compared to the amount of hemoglobin in the blood.[26]

The ratio of carboxyhemoglobin to hemoglobin molecules in an average person may be up to 5%, although cigarette smokers who smoke two packs per day may have levels up to 9%.[83] In symptomatic poisoned people they are often in the 10–30% range, while persons who die may have postmortem blood levels of 30–90%.[84][85]

As people may continue to experience significant symptoms of CO poisoning long after their blood carboxyhemoglobin concentration has returned to normal, presenting to examination with a normal carboxyhemoglobin level (which may happen in late states of poisoning) does not rule out poisoning.[86]

### Measuring[edit | edit source]

Carbon monoxide may be quantitated in blood using spectrophotometric methods or chromatographic techniques in order to confirm a diagnosis of poisoning in a person or to assist in the forensic investigation of a case of fatal exposure.

A CO-oximeter can be used to determine carboxyhemoglobin levels.[87][88] Pulse CO-oximeters estimate carboxyhemoglobin with a non-invasive finger clip similar to a pulse oximeter.[89] These devices function by passing various wavelengths of light through the fingertip and measuring the light absorption of the different types of hemoglobin in the capillaries.[90] The use of a regular pulse oximeter is not effective in the diagnosis of carbon monoxide poisoning as people with carbon monoxide poisoning may have a normal oxygen saturation level on a pulse oximeter.[91] This is due to the carboxyhemoglobin being misrepresented as oxyhemoglobin.[92]

Breath CO monitoring offers an alternative to pulse CO-oximetry. Carboxyhemoglobin levels have been shown to have a strong correlation with breath CO concentration.[93][94] However, many of these devices require the user to inhale deeply and hold their breath to allow the CO in the blood to escape into the lung before the measurement can be made. As this is not possible in people who are unresponsive, these devices may not appropriate for use in on-scene emergency care detection of CO poisoning.

### Differential diagnosis[edit | edit source]

There are many conditions to be considered in the differential diagnosis of carbon monoxide poisoning.[16][31] The earliest symptoms, especially from low level exposures, are often non-specific and readily confused with other illnesses, typically flu-like viral syndromes, depression, chronic fatigue syndrome, chest pain, and migraine or other headaches.[95] Carbon monoxide has been called a "great mimicker" due to the presentation of poisoning being diverse and nonspecific.[16] Other conditions included in the differential diagnosis include acute respiratory distress syndrome, altitude sickness, lactic acidosis, diabetic ketoacidosis, meningitis, methemoglobinemia, or opioid or toxic alcohol poisoning.[31]

## Prevention[edit | edit source]

Carbon monoxide detector connected to a North American power outlet

### Detectors[edit | edit source]

A carbon monoxide monitor clipped to the uniform of a paramedic

Prevention remains a vital public health issue, requiring public education on the safe operation of appliances, heaters, fireplaces, and internal-combustion engines, as well as increased emphasis on the installation of carbon monoxide detectors.[13] Carbon monoxide is tasteless, odourless, and colourless, and therefore can not be detected by visual cues or smell.[96]

The United States Consumer Product Safety Commission has stated, "carbon monoxide detectors are as important to home safety as smoke detectors are," and recommends each home have at least one carbon monoxide detector, and preferably one on each level of the building.[97] These devices, which are relatively inexpensive[98] and widely available, are either battery- or AC-powered, with or without battery backup.[99] In buildings, carbon monoxide detectors are usually installed around heaters and other equipment. If a relatively high level of carbon monoxide is detected, the device sounds an alarm, giving people the chance to evacuate and ventilate the building.[98][100] Unlike smoke detectors, carbon monoxide detectors do not need to be placed near ceiling level.

The use of carbon monoxide detectors has been standardized in many areas. In the US, NFPA 720-2009,[101] the carbon monoxide detector guidelines published by the National Fire Protection Association, mandates the placement of carbon monoxide detectors/alarms on every level of the residence, including the basement, in addition to outside sleeping areas. In new homes, AC-powered detectors must have battery backup and be interconnected to ensure early warning of occupants at all levels.[101] NFPA 720-2009 is the first national carbon monoxide standard to address devices in non-residential buildings. These guidelines, which now pertain to schools, healthcare centers, nursing homes and other non-residential buildings, include three main points:[101]

1\. A secondary power supply (battery backup) must operate all carbon monoxide notification appliances for at least 12 hours,
2\. Detectors must be on the ceiling in the same room as permanently installed fuel-burning appliances, and
3\. Detectors must be located on every habitable level and in every HVAC zone of the building.

Gas organizations will often recommend to get gas appliances serviced at least once a year.[102]

### Legal requirements[edit | edit source]

The NFPA standard is not necessarily enforced by law. As of April 2006, the US state of Massachusetts requires detectors to be present in all residences with potential CO sources, regardless of building age and whether they are owner-occupied or rented.[103] This is enforced by municipal inspectors, and was inspired by the death of 7-year-old Nicole Garofalo in 2005 due to snow blocking a home heating vent.[104] Other jurisdictions may have no requirement or only mandate detectors for new construction or at time of sale.

Despite similar deaths in vehicles with clogged exhaust pipes (for example in the Northeastern United States blizzard of 1978 and February 2013 nor'easter) and the commercial availability of the equipment, there is no legal requirement for automotive CO detectors.[citation needed]

### Air quality[edit | edit source]

The following guideline values (ppm values rounded) and periods of time-weighted average exposures have been determined in such a way that the carboxyhaemoglobin (COHb) level of 2.5% is not exceeded, even when a normal subject engages in light or moderate exercise:

* 100 mg/m3 (87 ppm) for 15 min
* 60 mg/m3 (52 ppm) for 30 min
* 30 mg/m3 (26 ppm) for 1 h
* 10 mg/m3 (9 ppm) for 8 h
* 7 mg/m3 (6 ppm) for 24 h (for indoor air quality, so as not to exceed 2% COHb for chronic exposure)[105]

## Treatment[edit | edit source]

Time to remove 50% carboxyhemoglobin[106] Oxygen pressure О2 | Time

|

21% oxygen at normal atmospheric pressure (fresh air)  | 5 hours 20 min
100% oxygen at normal atmospheric pressure (non-rebreather oxygen mask)  | 1 hours 20 min
100% hyperbaric oxygen (3 atmospheres absolute)  | 23 min

Initial treatment for carbon monoxide poisoning is to immediately remove the person from the exposure without endangering further people. Those who are unconscious may require CPR on site.[38] Administering oxygen via non-rebreather mask shortens the half-life of carbon monoxide from 320 minutes, when breathing normal air, to only 80 minutes.[30] Oxygen hastens the dissociation of carbon monoxide from carboxyhemoglobin, thus turning it back into hemoglobin.[14][107] Due to the possible severe effects in the baby, pregnant women are treated with oxygen for longer periods of time than non-pregnant people.[108]

### Hyperbaric oxygen[edit | edit source]

A person within a hyperbaric oxygen chamber

Hyperbaric oxygen is also used in the treatment of carbon monoxide poisoning, as it may hasten dissociation of CO from carboxyhemoglobin[14] and cytochrome oxidase[109] to a greater extent than normal oxygen. Hyperbaric oxygen at three times atmospheric pressure reduces the half life of carbon monoxide to 23 (~80/3 minutes) minutes, compared to 80 minutes for oxygen at regular atmospheric pressure.[14] It may also enhance oxygen transport to the tissues by plasma, partially bypassing the normal transfer through hemoglobin.[107] However, it is controversial whether hyperbaric oxygen actually offers any extra benefits over normal high flow oxygen, in terms of increased survival or improved long-term outcomes.[110][111][112][113][114][115] There have been randomized controlled trials in which the two treatment options have been compared;[116][117][118][119][120][121] of the six performed, four found hyperbaric oxygen improved outcome and two found no benefit for hyperbaric oxygen.[110] Some of these trials have been criticized for apparent flaws in their implementation.[122][123][124][125] A review of all the literature concluded that the role of hyperbaric oxygen is unclear and the available evidence neither confirms nor denies a medically meaningful benefit. The authors suggested a large, well designed, externally audited, multicentre trial to compare normal oxygen with hyperbaric oxygen.[110]

### Other[edit | edit source]

Further treatment for other complications such as seizure, hypotension, cardiac abnormalities, pulmonary edema, and acidosis may be required. Increased muscle activity and seizures should be treated with dantrolene or diazepam; diazepam should only be given with appropriate respiratory support.[38] Hypotension requires treatment with intravenous fluids; vasopressors may be required to treat myocardial depression.[126] Cardiac dysrhythmias are treated with standard advanced cardiac life support protocols.[26] If severe, metabolic acidosis is treated with sodium bicarbonate. Treatment with sodium bicarbonate is controversial as acidosis may increase tissue oxygen availability.[127] Treatment of acidosis may only need to consist of oxygen therapy.[26][31] The delayed development of neuropsychiatric impairment is one of the most serious complications of carbon monoxide poisoning. Brain damage is confirmed following MRI or CAT scans.[25][128][129] Extensive follow up and supportive treatment is often required for delayed neurological damage.[30] Outcomes are often difficult to predict following poisoning,[130] especially people who have symptoms of cardiac arrest, coma, metabolic acidosis, or have high carboxyhemoglobin levels.[31] One study reported that approximately 30% of people with severe carbon monoxide poisoning will have a fatal outcome.[69] It has been reported that electroconvulsive therapy (ECT) may increase the likelihood of delayed neuropsychiatric sequelae (DNS) after carbon monoxide (CO) poisoning.[131] A device that also provides some carbon dioxide to stimulate faster breathing (sold under the brand name ClearMate) may also be used.[132]

## Epidemiology[edit | edit source]

See also: Category:Deaths from carbon monoxide poisoning.

The true number of cases of carbon monoxide poisoning is unknown, since many non-lethal exposures go undetected.[25][69] From the available data, carbon monoxide poisoning is the most common cause of injury and death due to poisoning worldwide.[133] Poisoning is typically more common during the winter months.[16][134][135][136] This is due to increased domestic use of gas furnaces, gas or kerosene space heaters, and kitchen stoves during the winter months, which if faulty and/or used without adequate ventilation, may produce excessive carbon monoxide.[16][137] Carbon monoxide detection and poisoning also increases during power outages, when electric heating and cooking appliances become inoperative and residents may temporarily resort to fuel-burning space heaters, stoves, and grills (some of which are safe only for outdoor use but nonetheless are errantly burned indoors).[138][139][140]

It has been estimated that more than 40,000 people per year seek medical attention for carbon monoxide poisoning in the United States.[141] 95% of carbon monoxide poisoning deaths in the United States are due to gas space heaters.[142][143] In many industrialized countries carbon monoxide is the cause of more than 50% of fatal poisonings.[10] In the United States, approximately 200 people die each year from carbon monoxide poisoning associated with home fuel-burning heating equipment.[97] Carbon monoxide poisoning contributes to the approximately 5613 smoke inhalation deaths each year in the United States.[144] The CDC reports, "Each year, more than 500 Americans die from unintentional carbon monoxide poisoning, and more than 2,000 commit suicide by intentionally poisoning themselves."[145] For the 10-year period from 1979 to 1988, 56,133 deaths from carbon monoxide poisoning occurred in the United States, with 25,889 of those being suicides, leaving 30,244 unintentional deaths.[144] A report from New Zealand showed that 206 people died from carbon monoxide poisoning in the years of 2001 and 2002. In total carbon monoxide poisoning was responsible for 43.9% of deaths by poisoning in that country.[146] In South Korea, 1,950 people had been poisoned by carbon monoxide with 254 deaths from 2001 through 2003.[147] A report from Jerusalem showed 3.53 per 100,000 people were poisoned annually from 2001 through 2006.[148] In Hubei, China, 218 deaths from poisoning were reported over a 10-year period with 16.5% being from carbon monoxide exposure.[149]

## History[edit | edit source]

The earliest description of carbon monoxide poisoning dates to at least 200 BC by Aristotle.[150] Documented cases of carbon monoxide being used as a method of suicide date to at least 100 BC in ancient Rome.[150] In the AD 350s, the Roman emperor Julian suffered from carbon monoxide poisoning in Paris, and later described it in his work Misopogon: "though the winter weather prevailed and continually increased in severity, even so I did not allow my servants to heat the house, because I was afraid of drawing out the dampness in the walls; but I ordered them to carry in fire that had burned down and to place in the room a very moderate number of hot coals. But the coals, though there were not very many of them, brought out from the walls quantities of steam and this made me fall asleep. And since my head was filled with the fumes I was almost choked. Then I was carried outside."[151] This misunderstanding of the causes of carbon monoxide poisoning may have caused the death of Julian's successor, Jovian.

John Scott Haldane identified carbon monoxide as the lethal constituent of afterdamp, the gas created by combustion, after examining many bodies of miners killed in pit explosions. Their skin was coloured cherry-pink from carboxyhaemoglobin, the stable compound formed in the blood by reaction with the gas. As a result of his research, he was able to design respirators for rescue workers. He tested the effect of carbon monoxide on his own body in a closed chamber, describing the results of his slow poisoning. In the late 1890s, he introduced the use of small animals for miners to detect dangerous levels of carbon monoxide underground, either white mice or canaries. With a faster metabolism, they showed the effects of poisoning before gas levels became critical for the workers, and so gave an early warning of the problem. The canary in British pits was replaced in 1986 by the electronic gas detector.

As part of the Holocaust during World War II, German Nazis used gas vans at Chelmno extermination camp and elsewhere to kill an estimated over 700,000 prisoners by carbon monoxide poisoning. This method was also used in the gas chambers of several death camps such as Treblinka, Sobibor and Belzec. Gassing with carbon monoxide started in action T4, the programme developed by the Nazis in Germany to murder the mentally ill and disabled people before the war started in earnest. The gas was supplied by IG Farben in pressurized cylinders and fed by tubes into the gas chambers built at various mental hospitals, such as Hartheim Euthanasia Centre. Many key personnel were recruited from the T4 programme to murder much larger numbers of people in the gas vans and the special gas chambers used in the death camps such as Treblinka. Exhaust fumes from tank engines for example, were used to supply the gas to the chambers.[152]

The worst accidental mass poisoning from carbon monoxide occurred on 3 March 1944 in Balvano, Italy, when a freight train with many illegal passengers stalled in a tunnel, leading to the death of over 500 people.[153]

The use of oxygen as treatment began in 1868.[150] The use of hyperbaric oxygen in rats following poisoning was studied by Haldane in 1895 while its use in humans began in the 1960s.[150]

## Research[edit | edit source]

Carbon monoxide is produced naturally by the body as a byproduct of converting protoporphyrin into bilirubin. This carbon monoxide also combines with hemoglobin to make carboxyhemoglobin, but not at toxic levels.[26]

Small amounts of CO are beneficial and enzymes exist that produce it at times of oxidative stress. Drugs are being developed to introduce small amounts of CO during certain kinds of surgery, these drugs are called carbon monoxide-releasing molecules.[154]

## References[edit | edit source]

1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Health, National Center for Environmental (30 December 2015). "Carbon Monoxide Poisoning – Frequently Asked Questions". www.cdc.gov. Archived from the original on 5 July 2017. Retrieved 2 July 2017.
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113. ↑ Olson KR (2005). "Hyperbaric oxygen or normobaric oxygen?". Toxicological Reviews. 24 (3): 151, discussion 159–60. doi:10.2165/00139709-200524030-00003. PMID 16390212.
114. ↑ Seger D (2005). "The myth". Toxicological Reviews. 24 (3): 155–56. doi:10.2165/00139709-200524030-00005. PMID 16390214.
115. ↑ Thom SR (2005). "Hyperbaric oxygen therapy for carbon monoxide poisoning: Is it time to end the debates?". Toxicological Reviews. 24 (3): 157–58. doi:10.2165/00139709-200524030-00006. PMID 16390215.
116. ↑ Scheinkestel CD, Bailey M, Myles PS, Jones K, Cooper DJ, Millar IL, Tuxen DV (March 1999). "Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomized controlled clinical trial" (Free full text). The Medical Journal of Australia. 170 (5): 203–10. doi:10.5694/j.1326-5377.1999.tb140318.x. PMID 10092916. Archived from the original on 2008-09-05.
117. ↑ Thom SR, Taber RL, Mendiguren II, Clark JM, Hardy KR, Fisher AB (April 1995). "Delayed neuropsychologic sequelae after carbon monoxide poisoning: prevention by treatment with hyperbaric oxygen". Annals of Emergency Medicine. 25 (4): 474–80. doi:10.1016/S0196-0644(95)70261-X. PMID 7710151.
118. ↑ Raphael JC, Elkharrat D, Jars-Guincestre MC, Chastang C, Chasles V, Vercken JB, Gajdos P (August 1989). "Trial of normobaric and hyperbaric oxygen for acute carbon monoxide intoxication". Lancet. 2 (8660): 414–19. doi:10.1016/S0140-6736(89)90592-8. PMID 2569600.
119. ↑ Ducasse JL, Celsis P, Marc-Vergnes JP (March 1995). "Non-comatose patients with acute carbon monoxide poisoning: hyperbaric or normobaric oxygenation?". Undersea & Hyperbaric Medicine. 22 (1): 9–15. PMID 7742714. Archived from the original on 2011-08-11. Retrieved 2007-10-05.
120. ↑ Mathieu D, Mathieu-Nolf M, Durak C, Wattel F, Tempe JP, Bouachour G, Sainty JM (1996). "Randomized prospective study comparing the effect of HBO vs 12 hours NBO in non-comatose CO-poisoned patients: results of the preliminary analysis". Undersea & Hyperbaric Medicine. 23: 7. Archived from the original on 2011-07-02. Retrieved 2008-05-16.
121. ↑ Weaver LK, Hopkins RO, Chan KJ, Churchill S, Elliott CG, Clemmer TP, Orme JF, Thomas FO, Morris AH (October 2002). "Hyperbaric oxygen for acute carbon monoxide poisoning". The New England Journal of Medicine. 347 (14): 1057–67. doi:10.1056/NEJMoa013121. PMID 12362006.
122. ↑ Gorman DF. (June 1999). "Hyperbaric or normobaric oxygen for acute carbon monoxide poisoning: a randomised controlled clinical trial. Unfortunate methodological flaws". The Medical Journal of Australia. 170 (11): 563, author reply 564–65. doi:10.5694/j.1326-5377.1999.tb127887.x. PMID 10397050. S2CID 28464628.
123. ↑ Scheinkestel CD, Jones K, Myles PS, Cooper DJ, Millar IL, Tuxen DV (April 2004). "Where to now with carbon monoxide poisoning?". Emergency Medicine Australasia. 16 (2): 151–54. doi:10.1111/j.1742-6723.2004.00567.x. PMID 15239731.
124. ↑ Isbister GK, McGettigan P, Harris I (February 2003). "Hyperbaric oxygen for acute carbon monoxide poisoning". The New England Journal of Medicine. 348 (6): 557–60. doi:10.1056/NEJM200302063480615. PMID 12572577.
125. ↑ Buckley NA, Juurlink DN (June 2013). "Carbon monoxide treatment guidelines must acknowledge the limitations of the existing evidence". American Journal of Respiratory and Critical Care Medicine. 187 (12): 1390. doi:10.1164/rccm.201212-2262LE. PMID 23767905.
126. ↑ Tomaszewski C (January 1999). "Carbon monoxide poisoning. Early awareness and intervention can save lives". Postgraduate Medicine. 105 (1): 39–40, 43–48, 50. doi:10.3810/pgm.1999.01.496. PMID 9924492. Archived from the original on 2021-08-28. Retrieved 2020-07-13.
127. ↑ Peirce EC (1986). "Treating acidemia in carbon monoxide poisoning may be dangerous". Journal of Hyperbaric Medicine. 1 (2): 87–97. Archived from the original on 2011-07-03. Retrieved 2009-10-29.
128. ↑ Devine SA, Kirkley SM, Palumbo CL, White RF (October 2002). "MRI and neuropsychological correlates of carbon monoxide exposure: a case report". Environmental Health Perspectives. 110 (10): 1051–55. doi:10.1289/ehp.021101051. PMC 1241033. PMID 12361932. Archived from the original on 2012-07-07.
129. ↑ O'Donnell P, Buxton PJ, Pitkin A, Jarvis LJ (April 2000). "The magnetic resonance imaging appearances of the brain in acute carbon monoxide poisoning". Clinical Radiology. 55 (4): 273–80. doi:10.1053/crad.1999.0369. PMID 10767186.
130. ↑ Seger D, Welch L (August 1994). "Carbon monoxide controversies: neuropsychologic testing, mechanism of toxicity, and hyperbaric oxygen". Annals of Emergency Medicine. 24 (2): 242–48. doi:10.1016/S0196-0644(94)70136-9. PMID 8037390.
131. ↑ Chiang, CL; Tseng, MC (27 September 2011). "Safe use of electroconvulsive therapy in a highly suicidal survivor of carbon monoxide poisoning". Gen Hosp Psychiatry. PMID 21958445.
132. ↑ "Press Announcements - FDA allows marketing of new device to help treat carbon monoxide poisoning". www.fda.gov. Archived from the original on 8 November 2020. Retrieved 21 March 2019.
133. ↑ Thom SR (October 2002). "Hyperbaric-oxygen therapy for acute carbon monoxide poisoning". The New England Journal of Medicine. 347 (14): 1105–06. doi:10.1056/NEJMe020103. PMID 12362013.
134. ↑ Ernst A, Zibrak JD (November 1998). "Carbon monoxide poisoning". The New England Journal of Medicine. 339 (22): 1603–08. doi:10.1056/NEJM199811263392206. PMID 9828249. Archived from the original on 2021-08-28. Retrieved 2020-07-13.
135. ↑ Centers for Disease Control and Prevention (CDC) (November 1996). "Deaths from motor-vehicle-related unintentional carbon monoxide poisoning—Colorado, 1996, New Mexico, 1980–1995, and United States, 1979–1992". MMWR. Morbidity and Mortality Weekly Report. 45 (47): 1029–32. PMID 8965803. Archived from the original on 2017-06-24.
136. ↑ Partrick M, Fiesseler F, Shih R, Riggs R, Hung O (2009). "Monthly variations in the diagnosis of carbon monoxide exposures in the emergency department". Undersea & Hyperbaric Medicine. 36 (3): 161–67. PMID 19860138.
137. ↑ Heckerling PS (May 1987). "Occult carbon monoxide poisoning: a cause of winter headache". The American Journal of Emergency Medicine. 5 (3): 201–04. doi:10.1016/0735-6757(87)90320-2. PMID 3580051.
138. ↑ "Department of Public Health Warns of Dangers of Carbon Monoxide Poisoning During Power Outages". Tower Generator. Archived from the original on 2012-04-26. Retrieved 2011-11-23.
139. ↑ "Avoiding Carbon Monoxide poisoning during a power outage". CDC. Archived from the original on 2011-12-12. Retrieved 2011-11-23.
140. ↑ Klein, Kelly; Herzog, Perri; Smolinske, Susan; White, Suzanne (2007). "Demand for poison control center services "surged" during the 2003 blackout". Clinical Toxicology. 45 (3): 248–54. doi:10.1080/15563650601031676. PMID 17453875. S2CID 29853571.
141. ↑ Hampson NB (September 1998). "Emergency department visits for carbon monoxide poisoning in the Pacific Northwest". The Journal of Emergency Medicine. 16 (5): 695–98. doi:10.1016/S0736-4679(98)00080-8. PMID 9752939.
142. ↑ "2004 Addendum to Overseas and Australian Statistics and Benchmarks for Customer Gas Safety Incidents" (PDF). Office of Gas Safety, Victoria. 2004. Archived from the original (PDF) on 2015-09-24.
143. ↑ "The risk of carbon monoxide poisoning from domestic gas appliances" (PDF). Report to the Department of Resources, Energy and Tourism. Feb 2012. Archived from the original (PDF) on 2015-03-12.
144. ↑ 144.0 144.1 Cobb N, Etzel RA (August 7, 1991). "Unintentional carbon monoxide-related deaths in the United States, 1979 through 1988". JAMA. 266 (5): 659–63. doi:10.1001/jama.266.5.659. PMID 1712865.
145. ↑ "Carbon Monoxide poisoning fact sheet" (PDF). Centers for Disease Control and Prevention. July 2006. Archived (PDF) from the original on 2008-12-18. Retrieved 2008-12-16.
146. ↑ McDowell R, Fowles J, Phillips D (November 2005). "Deaths from poisoning in New Zealand: 2001–2002". The New Zealand Medical Journal. 118 (1225): U1725. PMID 16286939. Archived from the original (Free full text) on 2011-07-14.
147. ↑ Song KJ, Shin SD, Cone DC (September 2009). "Socioeconomic status and severity-based incidence of poisoning: a nationwide cohort study". Clinical Toxicology. 47 (8): 818–26. doi:10.1080/15563650903158870. PMID 19640232. S2CID 22203132.
148. ↑ Salameh S, Amitai Y, Antopolsky M, Rott D, Stalnicowicz R (February 2009). "Carbon monoxide poisoning in Jerusalem: epidemiology and risk factors". Clinical Toxicology. 47 (2): 137–41. doi:10.1080/15563650801986711. PMID 18720104. S2CID 44624059.
149. ↑ Liu Q, Zhou L, Zheng N, Zhuo L, Liu Y, Liu L (December 2009). "Poisoning deaths in China: type and prevalence detected at the Tongji Forensic Medical Center in Hubei". Forensic Science International. 193 (1–3): 88–94. doi:10.1016/j.forsciint.2009.09.013. PMID 19854011.
150. ↑ 150.0 150.1 150.2 150.3 Penney, David G. (2007). Carbon Monoxide Poisoning. CRC Press. p. 754\. ISBN 978-0849384189. Archived from the original on 2017-09-10.
151. ↑ Julian, Misopogon 341C-D
152. ↑ Totten S, Bartrop P, Markusen E (2007). Dictionary of Genocide. Greenwood. pp. 129, 156. ISBN 978-0313346422. Archived from the original on 2013-05-26.
153. ↑ Haine, Edgar A. (1993). Railroad Wrecks. Associated University Presses. pp. 169–170. ISBN 0-8453-4844-2. Archived from the original on 2021-06-24. Retrieved 2020-07-13.
154. ↑ Foresti, R; Bani-Hani, MG; Motterlini, R (April 2008). "Use of carbon monoxide as a therapeutic agent: promises and challenges". Intensive Care Medicine. 34 (4): 649–58. doi:10.1007/s00134-008-1011-1. PMID 18286265.

## External links[edit | edit source]

* Centers for Disease Control and Prevention (CDC) – Carbon Monoxide – NIOSH Workplace Safety and Health Topic Archived 2020-07-14 at the Wayback Machine
* International Programme on Chemical Safety (1999). Carbon Monoxide Archived 2018-10-01 at the Wayback Machine, Environmental Health Criteria 213, Geneva: WHO

Classification|

* ICD-10: T58
* ICD-9-CM: 986
* MeSH: D002249

|

External resources|

* eMedicine: article/819987

* v
* t
* e

* Poisoning
* Toxicity
* Overdose

History of poison

Inorganic|

| Metals|

| Toxic metals|

* Beryllium
* Cadmium
* Lead
* Mercury
* Nickel
* Silver
* Thallium
* Tin

|

Dietary minerals|

* Chromium
* Cobalt
* Copper
* Iron
* Manganese
* Zinc

Metalloids|

* Arsenic

Nonmetals|

* Sulfuric acid
* Selenium
* Chlorine
* Fluoride

Organic|

| Phosphorus|

* Pesticides
* Aluminium phosphide
* Organophosphates

|

Nitrogen|

* Cyanide
* Nicotine
* Nitrogen dioxide poisoning

CHO|

* alcohol
* Ethanol
* Ethylene glycol
* Methanol
* Carbon monoxide
* Oxygen
* Toluene

Pharmaceutical|

| Drug overdoses|

| Nervous|

* Anticholinesterase
* Aspirin
* Barbiturates
* Benzodiazepines
* Cocaine
* Lithium
* Opioids
* Paracetamol
* Tricyclic antidepressants

|

Cardiovascular|

* Digoxin
* Dipyridamole

Vitamin poisoning|

* Vitamin A
* Vitamin D
* Vitamin E
* Megavitamin-B6 syndrome

Biological1|

| Fish / seafood|

* Ciguatera
* Haff disease
* Ichthyoallyeinotoxism
* Scombroid
* Shellfish poisoning
* Amnesic
* Diarrhetic
* Neurotoxic
* Paralytic

|

Other vertebrates|

* amphibian venom
* Batrachotoxin
* Bombesin
* Bufotenin
* Physalaemin
* birds / quail
* Coturnism
* snake venom
* Alpha-Bungarotoxin
* Ancrod
* Batroxobin

Arthropods|

* Arthropod bites and stings
* bee sting / bee venom
* Apamin
* Melittin
* scorpion venom
* Charybdotoxin
* spider venom
* Latrotoxin / Latrodectism
* Loxoscelism
* tick paralysis

Plants / fungi|

* Cinchonism
* Ergotism
* Lathyrism
* Locoism
* Mushrooms
* Strychnine

1 including venoms, toxins, foodborne illnesses.

* Category
* Commons
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* v
* t
* e

Underwater diving

* Diving modes
* Atmospheric pressure diving
* Freediving
* Saturation diving
* Scuba diving
* Snorkeling
* Surface oriented diving
* Surface-supplied diving
* Unmanned diving

Diving equipment

* Cleaning and disinfection of personal diving equipment
* Human factors in diving equipment design

| Basic equipment|

* Diving mask
* Snorkel
* Swimfin

|

Breathing gas|

* Bailout gas
* Bottom gas
* Breathing air
* Decompression gas
* Emergency gas supply
* Heliox
* Nitrox
* Oxygen
* Travel gas
* Trimix

Buoyancy and
trim equipment|

* Buoyancy compensator
* Power inflator
* Dump valve
* Diving weighting system
* Ankle weights
* Integrated weights
* Trim weights
* Weight belt

Decompression
equipment|

* Decompression buoy
* Decompression cylinder
* Decompression trapeze
* Dive computer
* Diving shot
* Jersey upline
* Jonline

Diving suit|

* Atmospheric diving suit
* Dry suit
* Sladen suit
* Standard diving suit
* Rash vest
* Wetsuit
* Dive skins
* Hot-water suit

Helmets
and masks|

* Anti-fog
* Diving helmet
* Free-flow helmet
* Lightweight demand helmet
* Orinasal mask
* Reclaim helmet
* Shallow water helmet
* Standard diving helmet
* Diving mask
* Band mask
* Full-face mask
* Half mask

Instrumentation|

* Bottom timer
* Depth gauge
* Dive computer
* Dive timer
* Diving watch
* Helium release valve
* Pneumofathometer
* Submersible pressure gauge

Mobility
equipment|

* Diving bell
* Closed bell
* Wet bell
* Diving stage
* Swimfin
* Monofin
* PowerSwim
* Towboard

| Diver
propulsion
vehicle|

* Advanced SEAL Delivery System
* Cosmos CE2F series
* Dry Combat Submersible
* Human torpedo
* Motorised Submersible Canoe
* Necker Nymph
* R-2 Mala-class swimmer delivery vehicle
* SEAL Delivery Vehicle
* Shallow Water Combat Submersible
* Siluro San Bartolomeo
* Wet Nellie
* Wet sub

|

Safety
equipment|

* Alternative air source
* Octopus regulator
* Pony bottle
* Bolt snap
* Buddy line
* Dive light
* Diver's cutting tool
* Diver's knife
* Diver's telephone
* Through-water communications
* Diving bell
* Diving safety harness
* Emergency gas supply
* Bailout block
* Bailout bottle
* Lifeline
* Screw gate carabiner
* Emergency locator beacon
* Rescue tether
* Safety helmet
* Shark-proof cage
* Snoopy loop
* Navigation equipment
* Distance line
* Diving compass
* Dive reel
* Line marker
* Surface marker buoy
* Silt screw

Underwater
breathing
apparatus|

* Atmospheric diving suit
* Diving cylinder
* Burst disc
* Diving cylinder valve
* Diving helmet
* Reclaim helmet
* Diving regulator
* Mechanism of diving regulators
* Regulator malfunction
* Regulator freeze
* Single-hose regulator
* Twin-hose regulator
* Full face diving mask

| Open-circuit
scuba|

* Scuba set
* Bailout bottle
* Decompression cylinder
* Independent doubles
* Manifolded twin set
* Scuba manifold
* Pony bottle
* Scuba configuration
* Sidemount
* Sling cylinder

|

Diving
rebreathers|

* Carbon dioxide scrubber
* Carleton CDBA
* CDLSE
* Cryogenic rebreather
* CUMA
* DSEA
* Dolphin
* Electro-galvanic oxygen sensor
* FROGS
* Halcyon PVR-BASC
* Halcyon RB80
* IDA71
* Interspiro DCSC
* KISS
* LAR-5
* LAR-6
* LAR-V
* LARU
* Porpoise
* Ray
* Siebe Gorman CDBA
* Siva
* Viper

Surface-supplied
diving equipment|

* Air line
* Diver's umbilical
* Diving air compressor
* Gas panel
* Hookah
* Scuba replacement
* Sea Trek
* Snuba
* Standard diving dress

Escape set|

* Davis Submerged Escape Apparatus
* Momsen lung
* Steinke hood
* Submarine Escape Immersion Equipment

Diving
equipment
manufacturers|

* AP Diving
* Apeks
* Aqua Lung America
* Aqua Lung/La Spirotechnique
* Beuchat
* René Cavalero
* Cis-Lunar
* Cressi-Sub
* Dacor
* DESCO
* Dive Xtras
* Divex
* Diving Unlimited International
* Drägerwerk
* Fenzy
* Maurice Fernez
* Technisub
* Oscar Gugen
* Heinke
* HeinrichsWeikamp
* Johnson Outdoors
* Mares
* Morse Diving
* Nemrod
* Oceanic Worldwide
* Porpoise
* Sub Sea Systems
* Shearwater Research
* Siebe Gorman
* Submarine Products
* Suunto

Diving support equipment

| Access equipment|

* Boarding stirrup
* Diver lift
* Diving bell
* Diving ladder
* Diving platform (scuba)
* Diving stage
* Downline
* Jackstay
* Launch and recovery system
* Messenger line
* Moon pool

|

Breathing gas
handling|

* Air filtration
* Activated carbon
* Hopcalite
* Molecular sieve
* Silica gel
* Booster pump
* Carbon dioxide scrubber
* Cascade filling system
* Diver's pump
* Diving air compressor
* Diving air filter
* Water separator
* High pressure breathing air compressor
* Low pressure breathing air compressor
* Gas blending
* Gas blending for scuba diving
* Gas panel
* Gas reclaim system
* Gas storage bank
* Gas storage quad
* Gas storage tube
* Helium analyzer
* Nitrox production
* Membrane gas separation
* Pressure swing adsorption
* Oxygen analyser
* Oxygen compatibility

Decompression
equipment|

* Built-in breathing system
* Decompression tables
* Diving bell
* Bell cursor
* Closed bell
* Clump weight
* Launch and recovery system
* Wet bell
* Diving chamber
* Diving stage
* Recreational Dive Planner
* Saturation system

Platforms|

* Dive boat
* Canoe and kayak diving
* Combat Rubber Raiding Craft
* Liveaboard
* Subskimmer
* Diving support vessel
* HMS Challenger (K07)

| Underwater
habitat|

* Aquarius Reef Base
* Continental Shelf Station Two
* Helgoland Habitat
* Jules' Undersea Lodge
* Scott Carpenter Space Analog Station
* SEALAB
* Tektite habitat

|

Remotely operated
underwater vehicles|

* 8A4-class ROUV
* ABISMO
* Atlantis ROV Team
* CURV
* Deep Drone
* Épaulard
* Global Explorer ROV
* Goldfish-class ROUV
* Kaikō ROV
* Kaşif ROUV
* Long-Term Mine Reconnaissance System
* Mini Rover ROV
* OpenROV
* ROV KIEL 6000
* ROV PHOCA
* Scorpio ROV
* Sea Dragon-class ROV
* Seabed tractor
* Seafox drone
* Seahorse ROUV
* SeaPerch
* SJT-class ROUV
* T1200 Trenching Unit
* VideoRay UROVs

Safety equipment|

* Diver down flag
* Diving shot
* Hyperbaric lifeboat
* Hyperbaric stretcher
* Jackstay
* Jonline
* Reserve gas supply

General|

* Diving spread
* Air spread
* Saturation spread
* Hot water system
* Sonar
* Underwater acoustic positioning system
* Underwater acoustic communication

Freediving

| Activities|

* Aquathlon
* Apnoea finswimming
* Freediving
* Haenyeo
* Pearl hunting
* Ama
* Snorkeling
* Spearfishing
* Underwater football
* Underwater hockey
* Underwater ice hockey
* Underwater rugby
* Underwater target shooting

|

Competitions|

* Nordic Deep
* Vertical Blue
* Disciplines
* Constant weight (CWT)
* Constant weight without fins (CNF)
* Dynamic apnea (DYN)
* Dynamic apnea without fins (DNF)
* Free immersion (FIM)
* No-limits apnea (NLT)
* Static apnea (STA)
* Skandalopetra diving
* Variable weight apnea (VWT)
* Variable weight apnea without fins

Equipment|

* Diving mask
* Diving suit
* Hawaiian sling
* Polespear
* Snorkel (swimming)
* Speargun
* Swimfins
* Monofin
* Water polo cap

Freedivers|

* Deborah Andollo
* Peppo Biscarini
* Sara Campbell
* Derya Can Göçen
* Goran Čolak
* Carlos Coste
* Robert Croft
* Mandy-Rae Cruickshank
* Yasemin Dalkılıç
* Leonardo D'Imporzano
* Flavia Eberhard
* Şahika Ercümen
* Emma Farrell
* Francisco Ferreras
* Pierre Frolla
* Flavia Eberhard
* Mehgan Heaney-Grier
* Elisabeth Kristoffersen
* Loïc Leferme
* Enzo Maiorca
* Jacques Mayol
* Audrey Mestre
* Karol Meyer
* Stéphane Mifsud
* Alexey Molchanov
* Natalia Molchanova
* Dave Mullins
* Patrick Musimu
* Guillaume Néry
* Herbert Nitsch
* Umberto Pelizzari
* Annelie Pompe
* Michal Risian
* Stig Severinsen
* Tom Sietas
* Aharon Solomons
* Martin Štěpánek
* Walter Steyn
* Tanya Streeter
* William Trubridge
* Devrim Cenk Ulusoy
* Danai Varveri
* Alessia Zecchini
* Nataliia Zharkova

Hazards|

* Barotrauma
* Drowning
* Freediving blackout
* Deep-water blackout
* Shallow-water blackout
* Hypercapnia
* Hypothermia

Historical|

* Ama
* Octopus wrestling
* Swimming at the 1900 Summer Olympics – Men's underwater swimming

Organisations|

* AIDA International
* Scuba Schools International
* Australian Underwater Federation
* British Freediving Association
* Confédération Mondiale des Activités Subaquatiques
* Fédération Française d'Études et de Sports Sous-Marins
* Performance Freediving International

Professional diving

| Occupations|

* Ama
* Commercial diver
* Commercial offshore diver
* Hazmat diver
* Divemaster
* Diving instructor
* Diving safety officer
* Diving superintendent
* Diving supervisor
* Haenyeo
* Media diver
* Police diver
* Public safety diver
* Scientific diver
* Underwater archaeologist

| Military diving|

* Army engineer diver
* Clearance diver
* Frogman
* List of military diving units
* Royal Navy ships diver
* Special Boat Service
* United States military divers
* U.S. Navy diver
* U.S.Navy master diver
* United States Navy SEALs
* Underwater Demolition Team

|

Underwater work|

* Commercial offshore diving
* Dive leader
* Diver training
* Recreational diver training
* Hyperbaric welding
* Media diving
* Nondestructive testing
* Pearl hunting
* Police diving
* Potable water diving
* Public safety diving
* Scientific diving
* Ships husbandry
* Sponge diving
* Submarine pipeline
* Underwater archaeology
* Archaeology of shipwrecks
* Underwater construction
* Offshore construction
* Underwater demolition
* Underwater photography
* Underwater search and recovery
* Underwater videography

| Salvage diving|

* SS Egypt
* Kronan
* La Belle
* SS Laurentic
* RMS Lusitania
* Mars
* Mary Rose
* USS Monitor
* HMS Royal George
* Vasa

|

Diving contractors|

* COMEX
* Helix Energy Solutions Group

Tools & equipment|

* Abrasive waterjet
* Airlift
* Baited remote underwater video
* In-water surface cleaning
* Brush cart
* Cavitation cleaning
* Pressure washing
* Pigging
* Lifting bag
* Remotely operated underwater vehicle
* Thermal lance
* Tremie
* Water jetting

Underwater
weapons|

* Limpet mine
* Speargun
* Hawaiian sling
* Polespear

| Underwater
firearm|

* Gyrojet
* Mk 1 Underwater Defense Gun
* Powerhead
* Underwater pistols
* Heckler & Koch P11
* SPP-1 underwater pistol
* Underwater revolvers
* AAI underwater revolver
* Underwater rifles
* ADS amphibious rifle
* APS underwater rifle
* ASM-DT amphibious rifle

|

Recreational diving

| Specialties|

* Altitude diving
* Cave diving
* Deep diving
* Ice diving
* Muck diving
* Open-water diving
* Rebreather diving
* Sidemount diving
* Solo diving
* Technical diving
* Underwater photography
* Wreck diving

|

Diver
organisations|

* British Sub-Aqua Club (BSAC)
* Cave Divers Association of Australia (CDAA)
* Cave Diving Group (CDG)
* Comhairle Fo-Thuinn (CFT)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Federación Española de Actividades Subacuáticas (FEDAS)
* Fédération Française d'Études et de Sports Sous-Marins (FFESSM)
* International Association for Handicapped Divers (IAHD)
* National Association for Cave Diving (NACD)
* Woodville Karst Plain Project (WKPP)

Diving tourism
industry|

* Dive center
* Environmental impact of recreational diving
* Scuba diving tourism
* Shark tourism
* Sinking ships for wreck diving sites

Diving events
and festivals|

* Diversnight
* Underwater Bike Race

Recreational
dive sites|

| Reef diving
regions|

* Aliwal Shoal Marine Protected Area
* Arrecifes de Cozumel National Park
* Edmonds Underwater Park
* Great Barrier Reef
* iSimangaliso Marine Protected Area
* Poor Knights Islands
* Table Mountain National Park Marine Protected Area

|

Reef dive
sites|

* Artificial reef
* Gibraltar Artificial Reef
* Shark River Reef
* Osborne Reef
* Fanadir
* Gamul Kebir
* Palancar Reef
* Underwater artworks
* Cancún Underwater Museum
* Christ of the Abyss
* Molinere Underwater Sculpture Park

Wreck diving
regions|

* Chuuk Lagoon
* Edmonds Underwater Park
* Finger Lakes Underwater Preserve Association
* Maritime Heritage Trail – Battle of Saipan
* Michigan Underwater Preserves
* Robben Island Marine Protected Area
* Table Mountain National Park Marine Protected Area
* Tulagi
* Tulamben
* Whitefish Point Underwater Preserve
* Wreck Alley, San Diego

Wreck dive
sites|

* HMS A1
* HMS A3
* USS Aaron Ward
* Abessinia
* Aeolian Sky
* Albert C. Field
* Andrea Doria
* Antilla
* Antilles
* Aquila
* USS Arkansas
* Bianca C.
* SS Binnendijk
* HMS Boadicea
* Booya
* HMSAS Bloemfontein
* Breda
* HMAS Brisbane
* HMHS Britannic
* Bungsberg
* HMAS Canberra
* Carl D. Bradley
* Carnatic
* SMS Dresden
* Dunraven
* Eastfield
* HMT Elk
* Ellengowan
* RMS Empress of Ireland
* HMS Falmouth
* Fifi
* SS Francisco Morazan
* Fujikawa Maru
* Fumizuki
* SATS General Botha
* USNS General Hoyt S. Vandenberg
* HMS Ghurka
* Glen Strathallan
* SAS Good Hope
* Gothenburg
* Herzogin Cecilie
* Hilma Hooker
* Hispania
* HMS Hood
* HMAS Hobart
* Igara
* James Eagan Layne
* Captain Keith Tibbetts
* King Cruiser
* SMS Kronprinz
* Kyarra
* HMS Laforey
* USAT Liberty
* Louis Sheid
* USS LST-507
* SMS Markgraf
* Mikhail Lermontov
* HMS M2
* Maine
* Maloja
* HMS Maori
* Marguerite
* SS Mauna Loa
* USAT Meigs
* Mendi
* USCGC Mohawk
* Mohegan
* RMS Moldavia
* HMS Montagu
* MV RMS Mulheim
* Nagato
* Oceana
* USS Oriskany
* Oslofjord
* P29
* P31
* Pedernales
* Persier
* HMAS Perth
* SAS Pietermaritzburg
* Piłsudski
* Pool Fisher
* HMS Port Napier
* Preußen
* President Coolidge
* PS Queen Victoria
* Radaas
* Rainbow Warrior
* RMS Rhone
* Rondo
* Rosehill
* Rotorua
* Royal Adelaide
* Royal Charter
* Rozi
* HMS Safari
* Salem Express
* USS Saratoga
* USS Scuffle
* HMS Scylla
* HMS Sidon
* USS Spiegel Grove
* Stanegarth
* Stanwood
* Stella
* HMAS Swan
* USS Tarpon
* Thesis
* Thistlegorm
* Toa Maru
* Torrey Canyon
* SAS Transvaal
* U-40
* U-352
* U-1195
* Um El Faroud
* Varvassi
* Walter L M Russ
* Washingtonian (1913)
* HMNZS Wellington
* USS Yancey
* Yongala
* Zenobia
* Zealandia
* Zingara

Cave diving
sites|

* Blauhöhle
* Chinhoyi Caves
* Devil's Throat at Punta Sur
* Engelbrecht Cave
* Fossil Cave
* Jordbrugrotta
* Piccaninnie Ponds
* Pluragrotta
* Pollatoomary
* Sistema Ox Bel Ha
* Sistema Sac Actun
* Sistema Dos Ojos
* Sistema Nohoch Nah Chich

Freshwater
dives|

* Dutch Springs
* Ewens Ponds
* Little Blue Lake

Training sites|

* Capernwray Dive Centre
* Deepspot
* National Diving and Activity Centre
* Stoney Cove

Open ocean
diving|

* Blue-water diving
* Black-water diving

Diving safety

* Human factors in diving equipment design
* Human factors in diving safety
* Life-support system
* Safety-critical system
* Scuba diving fatalities

| Diving
hazards|

* List of diving hazards and precautions
* Environmental
* Current
* Delta-P
* Entanglement hazard
* Overhead
* Silt out
* Wave action
* Equipment
* Freeflow
* Use of breathing equipment in an underwater environment
* Failure of diving equipment other than breathing apparatus
* Single point of failure
* Physiological
* Cold shock response
* Decompression
* Nitrogen narcosis
* Oxygen toxicity
* Seasickness
* Uncontrolled decompression
* Diver behaviour and competence
* Lack of competence
* Overconfidence effect
* Panic
* Task loading
* Trait anxiety
* Willful violation

| Consequences|

* Barotrauma
* Decompression sickness
* Drowning
* Hypothermia
* Hypoxia
* Hypercapnia
* Hyperthermia

|

Diving
procedures|

* Ascending and descending
* Emergency ascent
* Boat diving
* Canoe and kayak diving
* Buddy diving
* buddy check
* Decompression
* Decompression practice
* Pyle stop
* Ratio decompression
* Dive briefing
* Dive log
* Dive planning
* Scuba gas planning
* Diver communications
* Diving hand signals
* Diving line signals
* Diver voice communications
* Diver rescue
* Diver training
* Doing It Right
* Drift diving
* Gas blending for scuba diving
* Night diving
* Solo diving
* Water safety

Risk
management|

* Checklist
* Hazard identification and risk assessment
* Hazard analysis
* Job safety analysis
* Risk assessment
* Risk control
* Hierarchy of hazard controls
* Incident pit
* Lockout–tagout
* Permit To Work
* Redundancy
* Safety data sheet
* Situation awareness

| Diving team|

* Bellman
* Chamber operator
* Diver medical technician
* Diver's attendant
* Diving supervisor
* Diving systems technician
* Gas man
* Life support technician
* Stand-by diver

|

Equipment
safety|

* Breathing gas quality
* Testing and inspection of diving cylinders
* Hydrostatic test
* Sustained load cracking
* Diving regulator
* Breathing performance of regulators

Occupational
safety and
health|

* Approaches to safety
* Job safety analysis
* Risk assessment
* Toolbox talk
* Housekeeping
* Association of Diving Contractors International
* Code of practice
* Contingency plan
* Diving regulations
* Emergency procedure
* Emergency response plan
* Evacuation plan
* Hazardous Materials Identification System
* Hierarchy of hazard controls
* Administrative controls
* Engineering controls
* Hazard elimination
* Hazard substitution
* Personal protective equipment
* International Marine Contractors Association
* Occupational hazard
* Biological hazard
* Chemical hazard
* Physical hazard
* Psychosocial hazard
* Occupational hygiene
* Exposure assessment
* Occupational exposure limit
* Workplace health surveillance
* Safety culture
* Code of practice
* Diving safety officer
* Diving superintendent
* Health and safety representative
* Operations manual
* Safety meeting
* Standard operating procedure

Diving medicine

| Diving
disorders|

* List of signs and symptoms of diving disorders
* Cramp
* Motion sickness
* Surfer's ear

| Pressure
related|

* Alternobaric vertigo
* Barostriction
* Barotrauma
* Air embolism
* Aerosinusitis
* Barodontalgia
* Dental barotrauma
* Pulmonary barotrauma
* Compression arthralgia
* Decompression illness
* Dysbarism

| Oxygen|

* Freediving blackout
* Hyperoxia
* Hypoxia
* Oxygen toxicity

|

Inert gases|

* Avascular necrosis
* Decompression sickness
* Isobaric counterdiffusion
* Taravana
* Dysbaric osteonecrosis
* High-pressure nervous syndrome
* Hydrogen narcosis
* Nitrogen narcosis

Carbon dioxide|

* Hypercapnia
* Hypocapnia

Breathing gas
contaminants|

* Carbon monoxide poisoning

Immersion
related|

* Asphyxia
* Drowning
* Hypothermia
* Immersion diuresis
* Instinctive drowning response
* Laryngospasm
* Salt water aspiration syndrome
* Swimming-induced pulmonary edema

Treatment|

* Demand valve oxygen therapy
* First aid
* Hyperbaric medicine
* Hyperbaric treatment schedules
* In-water recompression
* Oxygen therapy
* Therapeutic recompression

Personnel|

* Diving Medical Examiner
* Diving Medical Practitioner
* Diving Medical Technician
* Hyperbaric nursing

Screening|

* Atrial septal defect
* Effects of drugs on fitness to dive
* Fitness to dive
* Psychological fitness to dive

Research|

| Researchers in
diving physiology
and medicine|

* Arthur J. Bachrach
* Albert R. Behnke
* Paul Bert
* George F. Bond
* Robert Boyle
* Albert A. Bühlmann
* John R. Clarke
* Guybon Chesney Castell Damant
* Kenneth William Donald
* William Paul Fife
* John Scott Haldane
* Robert William Hamilton Jr.
* Leonard Erskine Hill
* Brian Andrew Hills
* Felix Hoppe-Seyler
* Christian J. Lambertsen
* Simon Mitchell
* Charles Momsen
* John Rawlins R.N.
* Charles Wesley Shilling
* Edward D. Thalmann
* Jacques Triger

|

Diving medical
research
organisations|

* Aerospace Medical Association
* Divers Alert Network (DAN)
* Diving Diseases Research Centre (DDRC)
* Diving Medical Advisory Council (DMAC)
* European Diving Technology Committee (EDTC)
* European Underwater and Baromedical Society (EUBS)
* National Board of Diving and Hyperbaric Medical Technology
* Naval Submarine Medical Research Laboratory
* Royal Australian Navy School of Underwater Medicine
* Rubicon Foundation
* South Pacific Underwater Medicine Society (SPUMS)
* Southern African Underwater and Hyperbaric Medical Association (SAUHMA)
* Undersea and Hyperbaric Medical Society (UHMS)
* United States Navy Experimental Diving Unit (NEDU)

Law

* Civil liability in recreational diving
* Diving regulations
* Duty of care
* List of legislation regulating underwater diving
* Investigation of diving accidents
* UNESCO Convention on the Protection of the Underwater Cultural Heritage

History of underwater diving

* History of decompression research and development
* History of scuba diving
* List of researchers in underwater diving
* Timeline of diving technology
* Underwater diving in popular culture

| Archeological
sites|

* SS Commodore
* USS Monitor
* Queen Anne's Revenge
* Whydah Gally

|

Underwater art
and artists|

* The Diver
* Jason deCaires Taylor

Engineers
and inventors|

* William Beebe
* Georges Beuchat
* John R. Clarke
* Jacques Cousteau
* Charles Anthony Deane
* John Deane
* Ted Eldred
* Henry Fleuss
* Émile Gagnan
* Joseph-Martin Cabirol
* Christian J. Lambertsen
* Yves Le Prieur
* John Lethbridge
* Ernest William Moir
* Joseph Salim Peress
* Auguste Piccard
* Willard Franklyn Searle
* Augustus Siebe
* Jacques Triger

Equipment|

* Aqua-Lung
* RV Calypso
* SP-350 Denise
* Nikonos
* Porpoise regulator
* Standard diving dress
* Vintage scuba

Military and
covert operations|

* Raid on Alexandria (1941)
* Sinking of the Rainbow Warrior

Scientific projects|

* 1992 cageless shark-diving expedition
* Mission 31

Incidents|

| Dive boat incidents|

* Sinking of MV Conception
* Fire on MV Red Sea Aggressor

|

Diver rescues|

* Alpazat cave rescue
* Tham Luang cave rescue

Early diving|

* John Day (carpenter)
* Charles Spalding
* Ebenezer Watson

Freediving fatalities|

* Loïc Leferme
* Audrey Mestre
* Nicholas Mevoli
* Natalia Molchanova

Offshore
diving incidents|

* Byford Dolphin diving bell accident
* Drill Master diving accident
* Star Canopus diving accident
* Stena Seaspread diving accident
* Venture One diving accident
* Waage Drill II diving accident
* Wildrake diving accident

Professional
diving fatalities|

* Roger Baldwin
* John Bennett
* Victor F. Guiel Jr.
* Craig M. Hoffman
* Peter Henry Michael Holmes
* Johnson Sea Link accident
* Edwin Clayton Link
* Gerard Anthony Prangley
* Pier Skipness
* Robert John Smyth
* Albert D. Stover
* Richard A. Walker
* Lothar Michael Ward
* Joachim Wendler
* Bradley Westell
* Arne Zetterström

Scuba diving
fatalities|

* Ricardo Armbruster
* Allan Bridge
* David Bright
* Berry L. Cannon
* Cotton Coulson
* Cláudio Coutinho
* E. Yale Dawson
* Deon Dreyer
* Milan Dufek
* Sheck Exley
* Maurice Fargues
* Fernando Garfella Palmer
* Guy Garman
* Steve Irwin
* Jim Jones
* Henry Way Kendall
* Artur Kozłowski
* Chris and Chrissy Rouse
* Kirsty MacColl
* Agnes Milowka
* François de Roubaix
* Dave Shaw
* Wesley C. Skiles
* Dewey Smith
* Rob Stewart
* Esbjörn Svensson
* Josef Velek

Publications

| Manuals|

* NOAA Diving Manual
* U.S. Navy Diving Manual
* Basic Cave Diving: A Blueprint for Survival
* Underwater Handbook
* Bennett and Elliott's physiology and medicine of diving
* Encyclopedia of Recreational Diving
* The new science of skin and scuba diving
* Professional Diver's Handbook
* Basic Scuba

|

Standards and
Codes of Practice|

* Code of Practice for Scientific Diving (UNESCO)
* DIN 7876
* IMCA Code of Practice for Offshore Diving
* ISO 24801 Recreational diving services — Requirements for the training of recreational scuba divers

General non-fiction|

* The Darkness Beckons
* Goldfinder
* The Last Dive
* Shadow Divers
* The Silent World: A Story of Undersea Discovery and Adventure

Research|

* List of Divers Alert Network publications

Dive guides|

Training and registration

| Diver
training|

* Competence and assessment
* Competency-based learning
* Refresher training
* Skill assessment
* Diver training standard
* Diving instructor
* Diving school
* Occupational diver training
* Commercial diver training
* Military diver training
* Public safety diver training
* Scientific diver training
* Recreational diver training
* Introductory diving
* Teaching method
* Muscle memory
* Overlearning
* Stress exposure training

| Skills|

* Combat sidestroke
* Diver navigation
* Diver trim
* Ear clearing
* Frenzel maneuver
* Valsalva maneuver
* Finning techniques
* Scuba skills
* Buddy breathing
* Low impact diving
* Diamond Reef System
* Surface-supplied diving skills
* Underwater searches

|

Recreational
scuba
certification
levels|

| Core diving skills|

* Advanced Open Water Diver
* Autonomous diver
* CMAS* scuba diver
* CMAS** scuba diver
* Introductory diving
* Low Impact Diver
* Master Scuba Diver
* Open Water Diver
* Supervised diver

|

Leadership skills|

* Dive leader
* Divemaster
* Diving instructor
* Master Instructor

Specialist skills|

* Rescue Diver
* Solo diver

Diver training
certification
and registration
organisations|

* European Underwater Federation (EUF)
* International Diving Regulators and Certifiers Forum (IDRCF)
* International Diving Schools Association (IDSA)
* International Marine Contractors Association (IMCA)
* List of diver certification organizations
* National Oceanic and Atmospheric Administration (NOAA)
* Nautical Archaeology Society
* Universal Referral Program
* World Recreational Scuba Training Council (WRSTC)

| Commercial diver
certification
authorities|

* Australian Diver Accreditation Scheme (ADAS)
* Commercial diver registration in South Africa
* Divers Institute of Technology
* Health and Safety Executive (HSE)
* Department of Employment and Labour

|

Commercial diving
schools|

* Divers Academy International
* Norwegian diver school

Free-diving
certification
agencies|

* AIDA International (AIDA)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Performance Freediving International (PI)
* Scuba Schools International (SSI)

Recreational scuba
certification
agencies|

* American Canadian Underwater Certifications (ACUC)
* American Nitrox Divers International (ANDI)
* Association nationale des moniteurs de plongée (ANMP)
* British Sub-Aqua Club (BSAC)
* Comhairle Fo-Thuinn (CFT)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Federación Española de Actividades Subacuáticas (FEDAS)
* Fédération Française d'Études et de Sports Sous-Marins (FFESSM)
* Federazione Italiana Attività Subacquee (FIAS)
* Global Underwater Explorers (GUE)
* International Association for Handicapped Divers (IAHD)
* International Association of Nitrox and Technical Divers (IANTD)
* International Diving Educators Association (IDEA)
* Israeli Diving Federation (TIDF)
* National Academy of Scuba Educators (NASE)
* National Association of Underwater Instructors (NAUI)
* Nederlandse Onderwatersport Bond (NOB)
* Professional Association of Diving Instructors (PADI)
* Professional Diving Instructors Corporation (PDIC)
* Sub-Aqua Association (SAA)
* Scuba Diving International (SDI)
* Scuba Educators International (SEI)
* Scottish Sub Aqua Club (ScotSAC)
* Scuba Schools International (SSI)
* Türkiye Sualtı Sporları Federasyonu (TSSF)
* United Diving Instructors (UDI)
* YMCA SCUBA Program

Scientific diver
certification
authorities|

* American Academy of Underwater Sciences (AAUS)
* CMAS Scientific Committee

Technical
certification
agencies|

* American Nitrox Divers International (ANDI)
* British Sub-Aqua Club (BSAC)
* Confédération Mondiale des Activités Subaquatiques (CMAS)
* Diving Science and Technology (DSAT)
* Federazione Italiana Attività Subacquee (FIAS)
* International Association of Nitrox and Technical Divers (IANTD)
* Professional Association of Diving Instructors (PADI)
* Professional Diving Instructors Corporation (PDIC)
* Trimix Scuba Association (TSA)
* Technical Extended Range (TXR)

| Cave
diving|

* Cave Divers Association of Australia (CDAA)
* Cave Diving Group (CDG)
* Global Underwater Explorers (GUE)
* National Association for Cave Diving (NACD)
* National Speleological Society#Cave Diving Group (CDG)
* National Association of Underwater Instructors (NAUI)
* Technical Diving International (TDI)

|

Underwater sports

| Surface snorkeling|

* Finswimming

|

Snorkeling/breath-hold|

* Spearfishing
* Underwater football
* Underwater hockey
* Australia
* Turkey
* Underwater rugby
* Colombia
* United States
* Underwater target shooting

Breath-hold|

* Aquathlon
* Apnoea finswimming
* Freediving
* Underwater ice hockey

Open Circuit Scuba|

* Immersion finswimming
* Sport diving
* Underwater cycling
* Underwater orienteering
* Underwater photography

Rebreather|

* Underwater photography

Sports governing
organisations
and federations|

* International
* AIDA International
* Confédération Mondiale des Activités Subaquatiques)
* National
* AIDA Hellas
* Australian Underwater Federation
* British Freediving Association
* British Octopush Association
* British Underwater Sports Association
* Comhairle Fo-Thuinn
* Federación Española de Actividades Subacuáticas
* Fédération Française d'Études et de Sports Sous-Marins
* South African Underwater Sports Federation
* Türkiye Sualtı Sporları Federasyonu
* Underwater Society of America)

Competitions|

* 14th CMAS Underwater Photography World Championship

Underwater divers

| Pioneers
of diving|

* Eduard Admetlla i Lázaro
* Aquanaut
* James F. Cahill
* Jacques Cousteau
* Billy Deans
* Dottie Frazier
* Hans Hass
* Dick Rutkowski
* Teseo Tesei
* Arne Zetterström

|

Underwater
scientists
archaeologists and
environmentalists|

* Michael Arbuthnot
* Robert Ballard
* George Bass
* Mensun Bound
* Louis Boutan
* Hugh Bradner
* Cathy Church
* Eugenie Clark
* James P. Delgado
* Sylvia Earle
* John Christopher Fine
* George R. Fischer
* Anders Franzén
* Honor Frost
* Fernando Garfella Palmer
* David Gibbins
* Graham Jessop
* Swietenia Puspa Lestari
* Pilar Luna
* Robert F. Marx
* Anna Marguerite McCann
* Innes McCartney
* Charles T. Meide
* David Moore
* Mark M. Newell
* Lyuba Ognenova-Marinova
* John Peter Oleson
* Mendel L. Peterson
* Richard Pyle
* William R. Royal
* Margaret Rule
* Gunter Schöbel
* Stephanie Schwabe
* Myriam Seco
* E. Lee Spence
* Robert Sténuit
* Peter Throckmorton

Scuba record
holders|

* Pascal Bernabé
* Jim Bowden
* Mark Ellyatt
* Sheck Exley
* Nuno Gomes
* Claudia Serpieri
* Krzysztof Starnawski

Underwater
filmmakers
and presenters|

* Samir Alhafith
* David Attenborough
* Ramón Bravo
* Jean-Michel Cousteau
* Richie Kohler
* Ivan Tors
* Andrew Wight

Underwater
photographers|

* Tamara Benitez
* Georges Beuchat
* Adrian Biddle
* Jonathan Bird
* Eric Cheng
* Neville Coleman
* Jacques Cousteau
* John D. Craig
* Ben Cropp
* Bernard Delemotte
* David Doubilet
* John Christopher Fine
* Dermot FitzGerald
* Rodney Fox
* Ric Frazier
* Stephen Frink
* Peter Gimbel
* Monty Halls
* Hans Hass
* Henry Way Kendall
* Rudie Kuiter
* Joseph B. MacInnis
* Luis Marden
* Agnes Milowka
* Noel Monkman
* Steve Parish
* Zale Parry
* Pierre Petit
* Leni Riefenstahl
* Peter Scoones
* Brian Skerry
* Wesley C. Skiles
* E. Lee Spence
* Philippe Tailliez
* Ron Taylor
* Valerie Taylor
* Albert Tillman
* John Veltri
* Stan Waterman
* Michele Westmorland
* John Ernest Williamson
* J. Lamar Worzel

Underwater
explorers|

* Caves
* Graham Balcombe
* Sheck Exley
* Martyn Farr
* Jochen Hasenmayer
* Jill Heinerth
* Jarrod Jablonski
* William Hogarth Main
* Tom Mount
* Jack Sheppard
* Bill Stone
* Reefs
*   * Wrecks
* Leigh Bishop
* John Chatterton
* Clive Cussler
* Bill Nagle
* Aristotelis Zervoudis

Aquanauts|

* Andrew Abercromby
* Joseph M. Acaba
* Clayton Anderson
* Richard R. Arnold
* Serena Auñón-Chancellor
* Michael Barratt (astronaut)
* Robert L. Behnken
* Randolph Bresnik
* Timothy J. Broderick
* Justin Brown
* Berry L. Cannon
* Scott Carpenter
* Gregory Chamitoff
* Steve Chappell
* Catherine Coleman
* Robin Cook
* Craig B. Cooper
* Fabien Cousteau
* Philippe Cousteau
* Timothy Creamer
* Jonathan Dory
* Pedro Duque
* Sylvia Earle
* Jeanette Epps
* Sheck Exley
* Albert Falco
* Andrew J. Feustel
* Michael Fincke
* Satoshi Furukawa
* Ronald J. Garan Jr.
* Michael L. Gernhardt
* Christopher E. Gerty
* David Gruber
* Chris Hadfield
* Jeremy Hansen
* José M. Hernández
* John Herrington
* Paul Hill
* Akihiko Hoshide
* Mark Hulsbeck
* Emma Hwang
* Norishige Kanai
* Les Kaufman
* Scott Kelly
* Karen Kohanowich
* Timothy Kopra
* Dominic Landucci
* Jon Lindbergh
* Kjell N. Lindgren
* Michael López-Alegría
* Joseph B. MacInnis
* Sandra Magnus
* Thomas Marshburn
* Matthias Maurer
* K. Megan McArthur
* Craig McKinley
* Jessica Meir
* Simone Melchior
* Dorothy Metcalf-Lindenburger
* Andreas Mogensen
* Karen Nyberg
* John D. Olivas
* Takuya Onishi
* Luca Parmitano
* Nicholas Patrick
* Tim Peake
* Thomas Pesquet
* Marc Reagan
* Garrett Reisman
* Kathleen Rubins
* Dick Rutkowski
* Tara Ruttley
* David Saint-Jacques
* Josef Schmid
* Robert Sheats
* Dewey Smith
* Steve Squyres
* Heidemarie Stefanyshyn-Piper
* Robert Sténuit
* Hervé Stevenin
* Nicole Stott
* James Talacek
* Daniel M. Tani
* Robert Thirsk
* Bill Todd
* Mark T. Vande Hei
* Koichi Wakata
* Rex J. Walheim
* Shannon Walker
* John Morgan Wells
* Joachim Wendler
* Douglas H. Wheelock
* Peggy Whitson
* Dafydd Williams
* Jeffrey Williams
* Sunita Williams
* Gregory R. Wiseman
* Kimiya Yui

Writers and journalists|

* Michael C. Barnette
* Victor Berge
* Philippe Diolé
* Gary Gentile
* Bret Gilliam
* Bob Halstead
* Trevor Jackson
* Steve Lewis
* John Mattera

Rescuers|

* Craig Challen
* Richard Harris
* Rick Stanton
* John Volanthen

Frogmen|

* Lionel Crabb

Commercial salvors|

* Keith Jessop

Science of underwater diving

| Diving
physics|

* Breathing performance of regulators
* Buoyancy
* Archimedes' principle
* Neutral buoyancy
* Concentration
* Diffusion
* Molecular diffusion
* Force
* Oxygen fraction
* Permeation
* Psychrometric constant
* Solubility
* Henry's law
* Saturation
* Solution
* Supersaturation
* Surface tension
* Hydrophobe
* Surfactant
* Temperature
* Torricellian chamber
* Underwater acoustics
* Modulated ultrasound
* Underwater vision
* Snell's law
* Underwater computer vision
* Weight
* Apparent weight

| Gas laws|

* Amontons's law
* Boyle's law
* Charles's law
* Combined gas law
* Dalton's law
* Gay-Lussac's law
* Ideal gas law

|

Pressure|

* Absolute pressure
* Ambient pressure
* Atmospheric pressure
* Gauge pressure
* Hydrostatic pressure
* Metre sea water
* Partial pressure

Diving
physiology|

* Artificial gills
* Cold shock response
* Diving reflex
* Equivalent narcotic depth
* Lipid
* Maximum operating depth
* Metabolism
* Physiological response to water immersion
* Tissue
* Underwater vision

| Circulatory
system|

* Blood shift
* Patent foramen ovale
* Perfusion
* Pulmonary circulation
* Systemic circulation

|

Decompression
theory|

* Decompression models:
* Bühlmann decompression algorithm
* Haldane's decompression model
* Reduced gradient bubble model
* Thalmann algorithm
* Thermodynamic model of decompression
* Varying Permeability Model
* Equivalent air depth
* Equivalent narcotic depth
* Oxygen window in diving decompression
* Physiology of decompression

Respiration|

* Blood–air barrier
* Breathing
* CO₂ retention
* Dead space
* Gas exchange
* Hypocapnia
* Respiratory exchange ratio
* Respiratory quotient
* Respiratory system
* Work of breathing

Diving
environment|

| Classification|

* List of diving environments by type
* Altitude diving
* Benign water diving
* Confined water diving
* Deep diving
* Inland diving
* Inshore diving
* Muck diving
* Night diving
* Open-water diving
* Black-water diving
* Blue-water diving
* Penetration diving
* Cave diving
* Ice diving
* Wreck diving
* Recreational dive sites
* Underwater environment

|

Impact|

* Environmental impact of recreational diving
* Low impact diving

Environmental
factors|

* Algal bloom
* Currents:
* Current
* Longshore drift
* Ocean current
* Rip current
* Tidal race
* Undertow
* Upwelling
* Ekman transport
* Halocline
* Reef
* Coral reef
* Stratification
* Thermocline
* Tides
* Turbidity
* Wind wave
* Breaking wave
* Surf
* Surge
* Wave shoaling

Other

* Bathysphere
* Defense against swimmer incursions
* Diver detection sonar
* Offshore survey
* Underwater domain awareness

| Awards and events|

* Hans Hass Award
* International Scuba Diving Hall of Fame
* London Diving Chamber Dive Lectures
* NOGI Awards

|

Deep-submergence
vehicle|

* Aluminaut
* DSV Alvin
* American submarine NR-1
* Bathyscaphe
* Archimède
* FNRS-2
* FNRS-3
* FNRS-4
* Harmony class bathyscaphe
* Sea Pole-class bathyscaphe
* Trieste II
* Deepsea Challenger
* Ictineu 3
* JAGO
* Jiaolong
* Konsul-class submersible
* DSV Limiting Factor
* Russian submarine Losharik
* Mir
* Nautile
* Pisces-class deep submergence vehicle
* DSV Sea Cliff
* DSV Shinkai
* DSV Shinkai 2000
* DSV Shinkai 6500
* DSV Turtle
* DSV-5 Nemo

| Deep-submergence
rescue vehicle|

* LR5
* LR7
* MSM-1
* Mystic-class deep-submergence rescue vehicle
* DSRV-1 Mystic
* DSRV-2 Avalon
* NATO Submarine Rescue System
* Priz-class deep-submergence rescue vehicle
* Russian deep submergence rescue vehicle AS-28
* Russian submarine AS-34
* ASRV Remora
* SRV-300
* Submarine Rescue Diving Recompression System
* Type 7103 DSRV
* URF (Swedish Navy)

|

Special
interest
groups|

* Artificial Reef Society of British Columbia
* CMAS Europe
* Coral Reef Alliance
* Diving Equipment and Marketing Association
* Divers Alert Network
* Green Fins
* Historical Diving Society
* Karst Underwater Research
* Nautical Archaeology Program
* Nautical Archaeology Society
* Naval Air Command Sub Aqua Club
* Project AWARE
* Reef Check
* Reef Life Survey
* Rubicon Foundation
* Save Ontario Shipwrecks
* SeaKeys
* Sea Research Society
* Society for Underwater Historical Research
* Society for Underwater Technology
* Underwater Archaeology Branch, Naval History & Heritage Command

Submarine escape
and rescue|

* Escape trunk
* International Submarine Escape and Rescue Liaison Office
* McCann Rescue Chamber
* Submarine Escape and Rescue system (Royal Swedish Navy)
* Submarine escape training facility
* Submarine Escape Training Facility (Australia)
* Submarine rescue ship

Neutral buoyancy
facilities for
Astronaut training|

* Neutral Buoyancy Laboratory
* Neutral buoyancy pool
* Neutral buoyancy simulation as a training aid
* Neutral Buoyancy Simulator
* Space Systems Laboratory
* Yuri Gagarin Cosmonaut Training Center

Other|

* Nautilus Productions

* Category
* Commons
*   * Glossary
* Indexes: dive sites
* divers
* diving
*   * Outline
* Portal

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