Near Drowning in Humans

A Report of 36 Patients

¹ Division of Pulmonary Diseases, Department of Internal Medicine, Mt. Sinai Hospital, Miami Beach, Florida

The purpose of this study was to present the clinical, laboratory and roentgenographic data in 36 episodes of submersion, 32 in salt water and 4 in chlorinated pools. Ages ranged from 3 to 89 and 33 of 36 survived. Serum electrolyte changes were minimal, including slight hypokalemia in 17. Arterial blood gas analysis showed significant metabolic acidosis in 19 patients. Mean values for the entire group were pH 7.23, SD ± 17 and base excess —10 mEq/L, SD ± 9. Severe hypoxia was a constant finding, mean pO₂ 55 mm Hg, SD ± 24 breathing supplemental oxygen. Roentgenograms showed alveolar patterns of pulmonary edema in 27 of 32 patients. Treatment included intubation and mechanical ventilation in four of seven patients with respiratory acidosis. Oxygen therapy was given universally and intermittent positive pressure breathing was utilized in a majority. Metabolic acidosis was corrected rapidly by administration of sodium bicarbonate intravenously. Diuretics and supportive measures were utilized fully. Recognition and adequate treatment of marked physiologic abnormalities following submersion can only be accomplished by routine use of serial arterial blood gas analyses.