Mechanism of Circulatory Failure in Fresh and Sea Water Drowning

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Abstract
The process of fresh water drowning, as seen experimentally in the dog, is described. When the submerged dog inspires, water is aspirated into the bronchial tree. It then enters the blood with explosive rapidity, diluting all of the plasma constituents (except K) and causing extensive hemolysis. Simultaneously, a fulminating pulmonary edema occurs, with plasma proteins, etc. entering the lung fluids. Ventricular fibrillation soon supervenes, this being the immediate cause of death in some 80% of the animals. The cause for the fibrillation is suggested to be the lowering of the plasma Na in the presence of anoxia. Imminent fibrillation is aborted by injection of NaCl. A fully established fibrillation is not affected by such injection. The presumption is strong that man reacts in the same way, because the same sequence of events was seen in other species (cows, horses, pigs). Ventricular fibrillation is considered to be irremediable in accidental drowning. The process of drowning in sea water is also described: in this case the concentration of all blood electrolytes rapidly rises. Fibrillation does not occur.