It often results from faulty diving equipment or improper breathing techniques, allowing fine water droplets to reach the lower respiratory tract.

The condition begins with a cough, followed by shortness of breath, chest discomfort or pain, shivering, fever and other systemic symptoms.

The small size of the droplets allows them to reach the lower respiratory tract without significantly triggering the upper airway's cough reflex, hence getting aspirated without causing immediate symptoms during the dive.

This gradient draws water out of surrounding lung tissues into the alveoli and bronchioles, leading to irritation and inflammation.

Salt water can also cause oxidative stress, dilution of pulmonary surfactant, breakdown of the blood-air barrier, cellular degradation and cell death.

[6] A 1989 study estimated that 37 percent of deaths that occurred during recreational scuba diving in Australia and New Zealand in the 1980s involved salt water aspiration syndrome.

The study hypothesized—based on reports of the victim's symptoms and an analysis of their equipment—that the syndrome acted as an intermediate factor, exacerbating panic and exhaustion, which subsequently led to loss of consciousness and death by drowning.

[11] In 2019, a case study reported severe salt water aspiration syndrome caused by a beluga whale splash in an audience member during a show at Georgia Aquarium which required critical care.