Severe Hypernatremia From Sea Water Ingestion During Near-Drowning in a Hurricane

Hipernatremia por ingesta de agua de mar (PDF).

Ingestion of seawater, whether voluntaryl or accidental, and its clinical sequelae have not been amply reported in the literature. Although seawater ingestion has been directly observed in animal drowning experiments and is believed to occur during human drowning, it has not been reported to play a significant role in producing serum electrolyte abnormalities in neardrowning victims. Because of the high concentration of sodium in seawater (approximately 350 to 500 mmol per liter), ingestion of this fluid and subsequent absorption of electrolytes can lead to hypernatremia. This condition is caused not only by the addition to the body of proportionately more sodium than water, but by water loss from solute diuresis or osmotic diarrhea.
The near-drowning patient whose case is reported in this paper experienced unusual circumstances as the result of a shipwreck during the height of a hurricane; the patient’s immersion and involuntary seawater ingestion led to the development of severe hypematremia. This case is interesting not only because of the patient’s harrowing ordeal, but also because it illustrates the physiologic changes and clinical symptoms that can occur in a victim of near-drowning when significant quantities of seawater are ingested rather than aspirated. To my knowledge, the patient’s serum sodium levels are the highest reported in the literature on near-drowning.