The Effects of Fluid Volume in Seawater Drowning

Abstract

Cardiovascular and biochemical changes were studied in 24 mongrel dogs who aspirated from 1 ml to 29 ml (total immersion) of sea water per pound body weight. The survival rate following aspiration was inversely proportional to the quantity of fluid aspirated. Volume for volume, sea water was approximately twice as lethal as fresh water. The principal cardiovascular changes observed in all animals that failed to survive the experiment were a progressive hypotension and electrocardiographic evidence of progressive hypoxia. Three minutes following aspiration, there was an increase in concentration of serum electrolytes. The extent of these changes was found to be dependent upon the quantity of water aspirated. By 1 hr. post-aspiration, however, serum K, Ca and Na had returned to normal in all surviving animals. Asphyxia, as evidenced by an increase in PaCO2 (arterial CO2 pressure) and decrease in pH and PaO2 [arterial O2 pressure], developed immediately and a significant arterial hypoxemia was still present at the conclusion of the experiment in all surviving animals. All near-drowning victims, regardless of the type or quantity of water they aspirate, should be hospitalized and treated for hypoxia. Therapy should be continued at least until normal arterial PO2 [oxygen pressure] values can be demonstrated. While attempts are being made to restore normal oxygena-tion and ventilation perfusion relationships, the need for supportive drug, fluid and electrolytic therapy can be evaluated and correction be instituted where indicated.