Practice Lesson of the week

Secondary drowning in a patient with epilepsy

BMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7544.775 (Published 30 March 2006) Cite this as: BMJ 2006;332:775
  1. Stephanie Milne, medical student1,
  2. Andrew Cohen, anaesthesia and intensive care consultant (a.t.cohen@leeds.ac.uk)1
  1. 1 Intensive Care Unit, St James's Hospital, Leeds LS9 7TF
  1. Correspondence to: A T Cohen
  • Accepted 24 December 2005

Drowning is defined as death by suffocation after submersion in a liquid; near drowning is survival, at least temporarily, after aspiration of fluid into the lungs.1 2 Secondary drowning is death or serious clinical deterioration following near drowning after a period of relative wellbeing; it is not due to neurological causes, respiratory sequelae of inhaled foreign material, or secondary infection. Secondary drowning is caused by inadequate alveolar gas exchange, probably due to primary alveolar membrane dysfunction and loss of surfactant. It can happen after immersion in fresh water or salt water.35 Secondary drowning occurs in 2-5% of all submersion incidents.6 7

We report a patient who seemed to recover fully from near drowning. The diagnosis of secondary drowning was not made until several hours after admission with acute respiratory distress. We highlight the need to consider secondary drowning and describe its immediate care, diagnosis, and management.

Case report

A 44 year old woman with a history of hypertension and epilepsy had a tonic-clonic seizure while swimming unaccompanied in her local pool. She was submerged for about one minute then taken to the side of the pool, where the seizure continued for two minutes before stopping spontaneously. She seemed to recover fully and refused offers to be taken to the hospital, preferring to go home.

About an hour and a half after returning home she developed shortness of …

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